RN Utilization Management Specialist
20 hours ago
Location: Remote or Hybrid
Job Type: Full-time
Pay: $48-52/hr + (negotiable)
Experience: 2+ years of experience in Utilization Management, Appeals, or a strong analytical background
Responsibilities:
* Conduct reviews up to and including the appeal level, including chart screening, regulatory guidance, and insurer requirements
* Act as a resource for administrative and clinical staff in training, problem-solving, and clarifying determinations
* Provide technical assistance and conduct/participate in staff huddles
* Train and mentor new RNs as the project expands
Requirements:
* Knowledge and experience with electronic medical records
* Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff
* Excellent written and verbal skills
* Ability to work independently with little supervision
Benefits:
* Paid Sick Leave
* Health Benefits / Dental / Vision
* 401k
* Short Term Disability Insurance
* Term Life Insurance Plan
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