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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
- 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
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