State Licensed Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse to facilitate collaborative processes for prior authorization and appeal denials.

Key Responsibilities

• Establish and maintain relationships with healthcare providers, case managers, and payers in a telephonic setting
• Act as a subject matter expert on prior authorization and denials, advocating for patients and supporting healthcare provider offices
• Maintain accurate patient account records in a digital CRM and ensure compliance with program guidelines

Required Qualifications

• AD or Bachelor's Degree in Nursing (BSN, RN) with a valid nursing license
• Four or more years of nursing experience, preferably with telephonic experience
• Knowledge of medical insurance terminology and healthcare billing is a plus
• Experience with digital CRM systems and proficiency in Microsoft products
• Strong customer service experience and ability to work in a fast-paced environment