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August 23, 2019  
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<< Back To Search Results Chirag Singh
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Position Description

Essential Duties and Responsibilities:

Responsible for the effective and sufficient support of all Utilization Management activities to include prospective/pre-certification review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies.
Uses an established set of criteria, evaluates and authorizes the medical necessity of some inpatient and outpatient services.
Notifies provider of recommended changes in level of care.
Evaluates cases for quality of care and documents quality issues.
Issues letter to provider and member if the service meets certification criteria, and escalates to manager or Medical Director for review if the service does not meet certification criteria, and may issue denial letters.
May participate or assist in the planning of team, UM/QM, PCP, IPA and or Health Plan meetings.
Works with management team to achieve financial goals and operational objectives.


Current licensure as a Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN. At least one year clinical experience.
Excellent communication and interpersonal skills.
Excellent time management skills.
Working knowledge of the insurance industry and the overall claims process a plus.
Knowledge of UM and CM products.
Proficient in basic computer skills
Knowledge, Skills, Abilities Required:
Excellent interpersonal and communications skills with clinical staff, management, and all departments involved in the care of our customers.
Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
Ability to make decisions on what needs to be done based on clearly established guidelines
Able to work in a dynamic, fast-paced team environment and to promote team concepts

Computer Skills:

Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word

Additional Information

Salary: $30 - $35/hr
Employment Type: Contractor    
Position Location: Nashville TN
Job ID: Nurse4524
Number of Positions: 50

Contact Information

Chirag Singh
Phone: 973-774-4524
Fax: -

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