RN – Utilization Management
Read on to find out what you will need to succeed in this position, including skills, qualifications, and experience.
New York, NY – Midtown
$50–$55/hour
Monday–Friday, 9:00 AM–5:00 PM
Onsite for the first 6 months, then hybrid
Temp-to-perm opportunity
A healthcare organization in Midtown Manhattan is looking for an experienced RN Utilization Management professional to join its team.
This is a great opportunity for an RN with a health insurance or managed care background and strong experience on the payer side of utilization management.
What they’re looking for:
- NYS Registered Nurse with a Bachelor’s degree
- 3+ years of Medical/Surgical nursing experience
- 2+ years of Utilization Management experience
- Strong payer-side UM experience, including medical necessity reviews, prior authorizations, appeals, and benefit determinations
- Experience with concurrent, prospective, and retrospective reviews
- Strong knowledge of Milliman Care Guidelines (MCG)
- Comfortable working with productivity metrics, turnaround times, and quality standards
- Experience collaborating with Medical Consultants on denials and clinical determinations
- Strong clinical assessment, critical thinking, and communication skills
- DMS and/or QNXT experience is a major plus
Candidates coming from health insurance or managed care organizations are especially encouraged to apply. Hospital-based UM experience may also be considered, but payer-side experience is strongly preferred. xzgxqkn
You’ll be part of a collaborative team that includes other RN UM professionals, an Assistant Manager, Care Coordinators, and call center staff.
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Utilization Review Nurse in new york at Unknown Company
This position is listed as full time and hybrid.