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UR Specialist- Care Management (Remote)
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Job Description
- Req#: 31666
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere in Georgia
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and service delivery
- Competitive pay with potential for overtime as needed
What to Expect (Job Responsibilities):
- Perform insurance company notifications and obtain certifications and authorizations related to Utilization Review in Care Management
- Communicate clinical information and updates to insurance companies as required by contract or federal and state regulations
- Liaise with third-party payers regarding authorization or denial matters
- Notify Care Managers of potential denials and facilitate peer-to-peer discussions with physicians and payer medical directors
- Foster coordination between Care Managers and Social Work staff to meet patient needs
What is Required (Qualifications):
- Must be a Registered Nurse (RN) with a current Georgia license
- Minimum of 4-5 years of recent and relevant acute clinical care experience
- At least 1-2 years of Utilization Review experience in a hospital, managed care, or physician office practice setting
- Associate Degree in Nursing required; Bachelor's Degree in Nursing preferred
- Strong verbal and written communication skills
How to Stand Out (Preferred Qualifications):
- Certifications such as CCM (Certified Case Manager) or CPUR (Certified Professional in Utilization Review)
- Experience with electronic health records and Microsoft Office Suite
- Highly organized and detail-oriented with the ability to meet tight deadlines
#HealthcareServices #UtilizationReview #RemoteWork #CareerOpportunity #PatientCare
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