Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN to manage Utilization Management medical appeal cases, ensuring timeliness and compliance with NCQA, URAC and NJ/Federal regulations. The role includes mentoring and clinical liaison support to appeals staff and involvement in special management projects.
The position requires evaluating care against guidelines, reviewing records, presenting to Appeals Committee with coordination with independent URO, and providing 24/7
#J-18808-LjbffrClinical Appeals Resolution Nurse Analyst II in parsippany troy hills at Unknown Company
This position is listed as full time and onsite.