State Licensed Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Establish and maintain relationships with healthcare providers, payers, and clients in a telephonic setting
• Act as an expert on prior authorization processes, denials, and payer requirements
• Provide customer service and support for patients and healthcare providers regarding program enrollment and reimbursement processes

Required Qualifications

• AD or Bachelor's Degree in Nursing (BSN, RN) with a valid nursing license
• Four or more years of nursing experience; prior telephonic experience preferred
• Knowledge of medical insurance terminology and healthcare billing
• Experience with digital CRM systems
• Proficiency in Microsoft products