RN Utilization Management Specialist

20 hours ago


Great Neck, New York, United States Medix Full time
Job Title: Utilization Management Specialist

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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