Registered Nurse Medical Management Coordinator
Job Summary
Coordinating utilization and case management activities, the full-time Remote Registered Nurse Medical Management Coordinator will manage outpatient service reviews, facilitate clinical discussions, and maintain compliance with HIPAA guidelines while supporting the RHP Medical Management Committee.
Key responsibilities
- Oversee delegated Utilization Review activities for SRHS Health Plan and coordinate outpatient service reviews
- Facilitate discussions with the RHP Medical Director regarding clinical reviews and manage member/customer requests and complaints
- Maintain documentation and databases in compliance with URAC standards and communicate results of reviews to Third Party Administrators
Required qualifications
- Current Registered Nurse license
- Minimum of 5 years of clinical experience
- At least 3 years of experience in Utilization Management or Case Management
- Valid driver's license with a good driving record
- Ability to adapt to changes in the work environment and manage competing demands
Complete Job Description
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