Utilization Review Nurse

3 days ago

Albany, New York, United States Medix™ Full time
Job Title: Clinical Utilization Reviewer

Location: Flexible work arrangements available, including hybrid and fully onsite options.

Job Summary:

We are seeking a skilled Clinical Utilization Reviewer to join our team at Medix™. As a Clinical Utilization Reviewer, you will be responsible for reviewing medical claims and making determinations on the appropriateness of care.

Key Responsibilities:

  • Review medical claims and documentation to determine the necessity and appropriateness of care.
  • Make determinations on the level of care required and the associated costs.
  • Communicate with healthcare providers and patients to gather additional information and clarify documentation.
  • Collaborate with the IDR team to resolve complex cases.
  • Stay up-to-date with changing regulations and guidelines related to healthcare utilization review.

Requirements:

  • Bachelor of Science in Nursing (BSN) degree.
  • At least 2 years of experience in utilization management, appeals, or a related field.
  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal skills.
  • Ability to work in a fast-paced environment and meet productivity standards.

What We Offer:

  • Competitive hourly rate of $48-52/hour (negotiable).
  • Opportunities for professional growth and development.
  • A dynamic and supportive work environment.

How to Apply:

Please submit your application, including your resume and a cover letter, to [insert contact information].

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