Nurse Clinician / RN (9671)
Registered Nurse / RN | Chattanooga, TN | Contract
InGenesis is currently seeking a Registered Nurse / RN to work as a Nurse Clinician with our client located in Chattanooga, TN. In this role, you will perform thorough research and provide complete documentation for rationale to support determinations.
If you are local to Chattanooga, this will be a remote opportunity. Apply today and we’ll reach out to answer any questions you may have!
- Perform comprehensive pre-existing reviews.
- Review rider-related diagnoses, referrals, and appeals.
- Perform retrospective claim review, special review requests, and UM pre-certifications and appeals.
- Utilize medical appropriateness criteria, nursing judgement, and contractual eligibility.
- Perform or participate in special studies or projects/pilots as directed by departmental management.
- May mentor/train new incumbents and serve as a preceptor.
- Seek the advice of the Medical Director when medical judgment is required.
- Initiate referrals to accomplish discharge planning when such plans are evident at the time of the request e.g., telephone request for scheduled for total hip replacement.
- Assist non-clinical staff in performance of administrative reviews.
- Interact with Onsite and Case Management areas to ensure smooth transfer of member information across the continuum of care.
- Apply established vendor protocols for authorization processes
- Perform other duties as assigned.
- Current license as a Registered Nurse / RN in the state of Tennessee.
- 3+ years of varied clinical experience.
- Computer proficiency, including Microsoft Office programs.
- Excellent verbal and written communication skills.
- Strong skillset in problem-solving, organizational, and interpersonal skills.
- Ability to work independently and handle multiple tasks.
- Ability to adapt to a high-paced environment
- Bachelor’s degree in nursing.
- Proficient knowledge and ability to apply various accreditation requirements (URAC, NCQA, etc.).
- Proficient in interpreting benefits, contract language, look back periods, rider information, and medical policy/medical review criteria.
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.
InGenesis is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at https://www.ingenesis.com/careers/site-accommodations.