Job Description
Overview:
TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is an American multinational information technology services and consulting company and is a leading provider of information technology, consulting, and business process outsourcing services, dedicated helping the world's leading companies build stronger businesses.
Job Title: Registered Nurse Intake
Location: Phoenix, AZ, 85003
Duration: 6 Months
Job Type: Temporary Assignment
Work Type: Remote
Location: Phoenix, AZ, 85003
Duration: 6 Months
Job Type: Temporary Assignment
Work Type: Remote
Shift Timings: Monday to Friday, 8:00 AM to 5:00 PM CST.
Job Description:
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Job Responsibilities:
- Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.
- Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal.
- Ensures timely review, processing, and response to appeals in accordance with State, Federal and NCQA standards.
- Communicates with members, providers, facilities, and other departments regarding appeals requests.
- Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards.
- Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests.
- Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices.
- Performs other duties as assigned.
- Complies with all policies and standards.
- Requires a degree from an Accredited School of Nursing or Master s degree in Behavioral Health or Social Work and 2 4 years of related experience.
- Knowledge of NCQA, Medicare and Medicaid regulations preferred.
- Knowledge of utilization management processes preferred.
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required, or
- LCSW - Licensed Clinical Social Worker required, or
- LMHC - Licensed Mental Health Counselor required, or
- LPC - Licensed Professional Counselor required, or
- Licensed Marriage and Family Therapist (LMFT) required, or
- Licensed Psychologist required.
- RN license required.
- 2 4 Years of Experience
Numbers & Facts
| Location | Phoenix, AZ (Remote) |
| Industry | Computer/IT Services |
| Salary | $40 |
| Company Size | 100 to 499 employees |
| Year Founded | 2009 |
| Website | http://www.tekwissen.com/ |
About Company
WE THE TEKWISSEN PEOPLE
TekWissen offers you a broader portfolio of services, industry-leading solutions, and the meaningful innovations that give you greater flexibility and speed to respond to market dynamics, reduced costs and risk to improve enterprise performance, and increased productivity to enable growth.
To keep pace with global market demands, TekWissen keeps its finger on the pulse of change. Our organized approach to guiding a project from its inception to closure. Managing projects is becoming more and more important as we enter the digital era. To cope with the pace that this transition demands, a method is required to manage projects so they can yield quality work, while incorporating efficient use of time and resources.
Project involves identifying which quality standards are relevant to the project and determining how to satisfy them.
It is important to perform quality planning during the Planning Process and should be done alongside the other project planning processes because changes in the quality will likely require changes in the other planning processes, or the desired product quality may require a detailed risk analysis of an identified problem. It is important to remember that quality should be planned, designed, then built in, not added on after the fact.
Capabilities and accomplishments in one TekWissen business enhance the opportunity for success in the others. Put simply, TekWissen's unique combination of attributes promotes success.Skills
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