Care Manager Utilization Review Specialist

6 days ago


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

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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