Job Summary
An independent, not-for-profit health benefits organization is searching for a person to fill their position for a Remote Utilization Management Clinical Review Registered Nurse.
Core Responsibilities of this position include:
- Initiating referrals to ensure appropriate coordination of care
- Assisting non-clinical staff in performance of administrative reviews
- Seeking the advice of the Medical Director when appropriate, according to policy
Must meet the following requirements for consideration:
- 3 years - Clinical experience required
- Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence
- Working knowledge of URAC, NCQA and CMS accreditations
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Proficient in interpreting benefits, contract language
- Customer service oriented
