PRIMARY EMPHASIS

The Nurse Analyst is responsible for assessing the medical appropriateness of proposed or performed hospital/medical/surgical services in accordance with established criteria.   In some cases, only broad policy exists which will require the incumbent to exercise independent judgement based on sound program and medical practices.  The incumbent must also be able to identify unique medical requirements and apply clinical guidelines (Inter-Qual) sound case utilization principles.

NATURE AND SCOPE

¿    This position is extremely crucial in the maintenance of uniformity, quality, and consistency of benefit determination, administration, and application of Managed Care Programs.  Previous experience involving judgment and decision-making.

Registered Nurse-Review Analyst: 

Responsible for the approval or rejection of claims, admissions approvals, telephone triage, and/or benefit interpretation.  May be required to enter or reference data via PC and/or CRT terminal. Other related skills may be required to perform this job.The maximum hourly rate reflects budget estimates only and does not reflect the final negotiated rate. 

QUALIFICATIONS

¿    A current, active and unrestricted Registered Nurse (R.N.) License 
¿    A minimum of two (2) years work in direct patient care as a Registered Nurse.

All your information will be kept confidential according to EEO guidelines.