RN Utilization ManagementVirtualVocations • Savannah, Georgia, United States
RN Utilization Management
VirtualVocations • Savannah, Georgia, United States
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for an RN Utilization Management remote.
Key Responsibilities
Participates in designated committees and task forces related to the Utilization Management Program
Coordinates with various departments including utilization review, case management, and claims regarding case management issues
Documents and communicates quality concerns related to members to appropriate staff
Required Qualifications
Associate or Bachelor's Degree in Nursing
Current license to practice as a Registered Nurse in the home state or a compact nursing license
5-7 years of clinical nursing experience, with at least 2 years in utilization review or case management
Experience in an HMO insurance setting is preferred
Ability to conduct claim reviews for appropriate claims processing
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