Job Summary
An independent, not-for-profit health benefits organization is in need of a Remote Health Insurance Clinical Review Utilization Manager.
Candidates will be responsible for the following:
- Initiating referrals to ensure appropriate coordination of care
- Seeking the advice of the Medical Director when appropriate, according to policy
- Assisting non-clinical staff in performance of administrative reviews
Must meet the following requirements for consideration:
- Registered Nurse (RN) with active license in the state of Tennessee or
- Hold a license in the state of your residence if the state is participating in the Nurse Licensure Compact Law
- 3 years - Clinical experience
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Working knowledge of URAC, NCQA and CMS accreditations
- Excellent oral and written communication skills
