InGenesis RN / Utilization Review Nurse (9269) in Charleston, South Carolina
InGenesis is currently seeking a Registered Nurse / RN to perform Medical Review of clinical information using established criteria or clinical guidelines. In this role, you will provide support and review of medical claims and utilization practices. This is a special project needed for the next several months. Apply today and we’ll reach out to answer any questions you may have! Job Duties • Perform reviews of complex service claims, pre-authorizations, appeals, referrals for potential fraud, etc. • Make charge payment determinations. • Determine medical necessity and appropriateness of services. • Document justification of payments or denials. • Provide guidance, direction, and input as needed. • Provide education to non-medical staff. • Perform other duties as assigned. Minimum Qualifications • Current Registered Nurse / RN license in the State of South Carolina. • Associate degree in Nursing or graduate from accredited nursing school. • 2+ years of clinical experience. • Preferred: Experience in utilization or medical review. About InGenesis 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. EEOC Statement 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.