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Utilization Management RN - Revenue Integrity at Yale University - ApplyBlast

Utilization Management RN - Revenue Integrity

Yale University

1 day ago

4.2 on Glassdoor

Remote

Full Time

Medior

0 applicants

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About this role

The Clinical Reviewer role at Yale School of Medicine supports medical necessity reviews, authorization compliance, reimbursement optimization, and denial prevention. This non-patient-facing nursing position evaluates medical records, treatment plans, and payer policies to ensure services meet coverage criteria and regulatory standards. The role serves as a liaison between providers, payers, and operational teams to translate clinical information into payer-specific documentation and authorization strategies.

Responsibilities

Review medical records and treatment plans to ensure payer compliance and medical necessity
Prepare clinical summaries and rationales for denials and appeals processes
Collaborate with providers and operational teams to optimize reimbursement and prevent denials

Skills

Qualifications

Registered Nurse in the State of ConnecticutCertified Case Manager (CCM)Certified Professional Utilization Review (CPUR)Accredited Case Manager (ACM)

About Yale University

yale.edu

Headquarters

Yale, Michigan, United States

Company Size

10001+ employees

Founded

1701

View Profile

Yale University is a private Ivy League research university founded in 1701 and located in New Haven, Connecticut. The institution is known for its undergraduate, graduate, and professional programs, as well as its contributions to research, innovation, and global scholarship.