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UR Specialist- Care Management (Remote)


PayCompetitive
LocationGeorgia/Vermont
Employment typeFull-Time

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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
      - Supportive and collaborative work environment
      - Engaging in critical patient care management and insurance liaison activities
      - Comprehensive training and ongoing education programs available
      - Competitive salary commensurate with experience
      - Chance to work in a dynamic healthcare setting with a focus on patient needs

      What to Expect (Job Responsibilities):
      - Perform insurance company notifications and obtain necessary certifications and authorizations for Utilization Review
      - Communicate clinical information and updates to insurance companies as required
      - Liaise with third-party payers regarding Utilization Review requirements and authorization issues
      - Proactively communicate with Care Management and Social Work staff to coordinate patient care
      - Notify Care Managers of potential denials and facilitate peer-to-peer discussions with physicians and payers

      What is Required (Qualifications):
      - Must possess a 2-year Associate Degree in Nursing
      - 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 setting
      - Current Registered Nurse (RN) license in Georgia
      - Strong interpersonal and effective communication skills

      How to Stand Out (Preferred Qualifications):
      - Bachelor's Degree in Nursing
      - Certifications such as CCM or CPUR
      - Experience with electronic health records and Microsoft Office Suite
      - Highly organized with the ability to manage tight deadlines
      - Demonstrated ability to work under pressure in a fast-paced environment

      #HealthcareServices #UtilizationReview #PatientCare #NursingCareers #CareerGrowth

      "We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."
  • About the company

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