Industry: Accounting, Finance & Insurance•
5 - 7 years
Posted 168 days ago
Work days: Monday through Friday
Work hours: 8 a.m. to 4:30 p.m.
Oversees the accurate processing of claims that have been deferred for medical necessity review.
Ensures compliance with nationally recognized standards, and local, state and federal laws and regulations.
Identifies and implements process improvement opportunities.
Bachelor's degree in nursing.
Required Work Experience
Five years of clinical and utilization review, to include two years of supervisory or team lead experience, OR
Equivalent military supervisory experience in grade E4 or above.
Required Skills and Abilities
Excellent oral and written communications, organizational, customer-service, analytical, critical-thinking and presentation skills.
Proficient in spelling, grammar, punctuation and basic business math.
Ability to persuade, negotiate with or influence others, and to handle confidential or sensitive information with discretion.
Knowledge of government programs and guidelines, medical and legal terminology, and disease management and litigation processes.
Microsoft Office skills.
Active RN license in state hired, OR
An active, compact, multistate RN license as defined by the Nurse Licensure Compact (NLC).