West Virginia Licensed Utilization Coordinator

Job Summary

A company is looking for a Utilization Management Coordinator.

Key Responsibilities

• Assess concurrent denials and determine appropriate next steps for authorization and billing status
• Review medical records and provide recommendations for denial management based on clinical expertise
• Collaborate with internal and external teams to prevent and manage concurrent denials and optimize reimbursement

Required Qualifications

• Current Registered Nurse license or multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
• Four years of clinical experience in a hospital setting
• Three years of experience in Utilization Review, Clinical Appeals, or case management
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN) or Diploma preferred