Supporting health plan operations to ensure delivery of medically necessary, quality healthcare services. Reviewing provider and member appeals of denials. Flagging key information prior to external review. Position Requirements Include: Graduate of an accredited school of nursing.
Ensuring delivery of medically necessary, appropriate, timely, cost-effective and quality health care services. Supporting health plan operations. Required Skills: Three years of utilization management or discharge planning. Graduate of an accredited school of nursing.