Full Time, Employee
We have an opening for an RN. This position is responsible for managing requests for medical necessity review, researching new and experimental procedures, interpreting medical policies and current Medicare Guidelines.
- Must be currently licensed as an RNin the Commonwealth of Pennsylvania.
- A minimum of 5 years clinical experience working in an acute care hospital setting or/and 2 years of managed care/preauthorization experience.
- A proactive, critical thinker with knowledge of ICD 9·CM, CPT and HCPCS coding, managed care
principles and emerging treatment
- Knowledge of the insurance industry, health plan benefits and product lines (e.g., Medicaid, PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive)
- Knowledge of regulatory and accreditation standards and requirements preferred. (e.g., NCOA, American Accreditation HealthCare Commission)
- Preferred experience in a managed care organization with specific experience related to clinical management.
For more information, please send us your resume and an SGC representative will be in touch soon.