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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 in a supportive and collaborative environment focused on patient care
- Chance to make a positive impact on patient transitions and care management
- Engage in proactive communication with healthcare teams to enhance service delivery
- Competitive salary and benefits package
What to Expect (Job Responsibilities):
- Perform activities related to insurance notifications, certifications, and authorizations in Utilization Review
- Communicate clinical information and updates to insurance companies as required by regulations
- Liaison with third-party payers regarding Utilization Review requirements and authorization matters
- Notify Care Managers of potential denials and facilitate peer discussions with physicians and payers
- Foster coordination with Care Manager and Social Work staff to meet patient needs
What is Required (Qualifications):
- Must possess a current Registered Nurse (RN) license in Georgia
- Minimum of 4-5 years of recent and relevant acute clinical care experience
- At least 1-2 years of experience in Utilization Review within a hospital, managed care, or physician office setting
- Associate Degree in Nursing required; Bachelor’s Degree in Nursing preferred
- Strong interpersonal, analytical, and communication skills
How to Stand Out (Preferred Qualifications):
- Certification in Case Management (CCM) or Certified Professional in Utilization Review (CPUR)
- Bachelor’s Degree in Nursing
- Experience with electronic health records and Microsoft Office Suite
- Demonstrated ability to work in high-stress environments and manage fluctuating workloads
#HealthcareServices #UtilizationReview #RegisteredNurse #PatientCare #CareerOpportunity
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