CLINICAL REVIEW RN PRN
- Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations.
- Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
- Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
- Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
- Reviews and validates physician’s orders, reports progress and unusual occurrences on patients to the payer.
Welcome to Cooper University Health Care With a more than 135-year history of healing, Cooper is the place South Jersey turns to when they need care. As the leading academic medical system in the area, with South Jersey’s only Level 1 Trauma Center, more than 100 outpatient offices, and more than two million patient visits a year, it’s the perfect place to build a career of care in a truly diverse and inclusive environment. Whether you’re a medical professional or possess other skills, you’ll want to be with Cooper.
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