Clinical Appeals Consultant Prn

Intermountain Health

West Valley City, Utah, US
Base: $40.39 - $60.96 ph; bonus/equity: not specif...
Onsite
Evidence-based utilization criteria application
Insurance audit and appeal documentation
Administrative law judge hearing testimony
Intermountain Health is seeking a Clinical Appeals Consultant PRN in West Valley City, Utah, to review medical records and perform clinical assessments for appeals related to medical necessity. The ideal candidate will have significant experience in utilization review or care management and hold a valid RN license

Job Summary

  • The role involves using nationally recognized evidence-based utilization criteria to review medical records and perform clinical assessments for patient accounts.
  • Candidates must be prepared to attend and testify at hearings on behalf of the patient and Intermountain Healthcare when insurance companies dispute medical necessity.
  • The position offers a generous benefits package designed to foster a sustainable culture of wellness covering mind, body, and spirit.

Matching Summary

Match Score: 75

Intermountain Health is seeking a Clinical Appeals Consultant PRN in West Valley City, Utah, to review medical records and perform clinical assessments for appeals related to medical necessity. The ideal candidate will have significant experience in utilization review or care management and hold a valid RN license.

Salary

Base: $40.39 - $60.96 per hour; Bonus/Equity: Not specified; Benefits: Comprehensive wellness package included

Skills & Requirements

Must-have

  • Evidence-based utilization criteria application
  • Insurance audit and appeal documentation
  • Administrative Law Judge hearing testimony

Nice-to-have

  • Multidisciplinary team collaboration skills
  • Trend identification for denial management
  • Flexible work option availability

Key Requirements

  • Current valid RN License required
  • Graduate of accredited school of nursing required
  • Three years experience in utilization review or care management
  • Bachelor's degree preferred

Work Rights

Not specified

Tailored Resume

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