Care Manager Utilization Review Specialist
6 days ago
At Coffee Regional Medical Center, we are seeking a highly 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 that care delivered in the hospital setting will be reimbursed. This role requires excellent customer service skills, strong analytical and problem-solving abilities, and the ability to work effectively in high-stress situations.
Key Responsibilities:
- Communicate with payors to ensure timely reimbursement for hospital services
- Complete appeals for clinical denials in a timely and effective manner
- Collaborate with hospital staff to ensure accurate and complete clinical information is provided to payors
- Develop and maintain relationships with payors to ensure smooth communication and reimbursement processes
- Stay up-to-date on changing payor policies and procedures
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 Center offers a competitive salary and benefits package, as well as opportunities for professional growth and development.
How to Apply:
If you are a motivated and detail-oriented individual with excellent communication skills, we encourage you to apply for this exciting opportunity.
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