Utilization Review Nurse Auditor

Medasource is a leading consulting and professional services firm serving the healthcare industry, including Life Sciences, RCM/Payers, Technology, and Government. We’ve been recognized by both KLAS and Modern Healthcare for being good to our employees, consultants, clients, and communities. With over 100 clients, more than 2,000 active consultants, and over 30 locations across the U.S., we’re focused on propelling the future of healthcare, one client at a time.

Our client offers a range of services that help navigate the path to compliant revenue. The Payor Peer to Peer team reviews cases for which the authorization has been denied evaluating if the proper documentation was available to support the admission status, procedure, and care setting that was requested. The Nurse Author in Payor Peer to Peer advises our clients regarding the appropriateness of the request based on available documentation. Our goal is to assist our client facilities in ensuring proper billing and authorization level; thereby increasing clean claims submission and reducing accounts receivable days. This team can also serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.

Writing client-facing clinical reviews evaluating the authorization requested, documentation support or lack of support for that authorization, evidenced based criteria for that support, and complex clinical evaluation of the request as a whole Evaluation and interpretation of multiple types of hospital documentation as it relates to the requested authorization, including but not limited to emergency department documentation, history and physical, progress notes, interpretation of lab and imaging results, vital sign trends, physical and occupational therapy notes, and medication administration records Provide strength evaluation and recommendations to clients using a combination of understanding of commercially available criteria and clinical judgement for establishing medical necessity arguments in the setting of concurrent denials Nurses should be highly capable of working independently with a high level of performance in in a rapidly changing, fast paced environment. Successful nurses will meet or exceed minimum productivity and quality standards. Provide feedback regarding actionable root cause analysis of the specific cases to customer utilization review team and/or case managers regarding submitted case determinations. Provide written analysis of the case and perform case reviews across multiple specialties