Care Manager Utilization Review

1 week ago


Douglas, Georgia, United States Coffee Regional Medical C Full time
Job Title: Utilization Review Care Manager

Coffee Regional Medical C is seeking a skilled Utilization Review Care Manager to join our team.

Job Summary

The Utilization Review Care Manager will be responsible for coordinating communication between the hospital and third-party payors to ensure care delivered in the hospital setting will be reimbursed. This role requires excellent customer service skills, the ability to think critically and analytically, and strong verbal and written communication skills.

Key Responsibilities

  • Minimize denials by third-party payors by communicating clinical information timely.
  • Complete appeals for clinical denials timely and effectively.
  • Collaborate with hospital staff to ensure accurate and timely communication with payors.
  • Develop and maintain relationships with payors to ensure smooth reimbursement processes.

Requirements

  • LPN or RN licensure in good standing with the GA board of Nursing.
  • Minimum of three years varied hospital experience or comparable job-related experience.
  • 3-5 years of utilization review experience, preferred.

What We Offer

Coffee Regional Medical C offers a competitive salary and benefits package, as well as opportunities for professional growth and development.



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