Careers At HGS

Utilization Management Nurse

Job Code : HGS/271
ROSWELL |GA Permanent

Job Description

In this role, you will be responsible for utilizing clinical acumen and managed care expertise related to researching, resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for Medicare line of business with emphasis on privacy, accuracy, meeting all regulatory and compliance timelines.

What do we offer?
  • $32 an hour, with paid breaks
  • Fully Paid Training
  • Comprehensive health and dental plan after 90 days
  • 50% top up to your 401K contributions 
  • A Full-Time Schedule 
  • A Real opportunity to grow your career:
    • 90% of our Management staff started their career as a Customer Service Representative.
  • Tuition Reimbursement program:
    • Available after being part of the HGS team for one year.

Along with a passion for helping people we look for: 
  • US state licensed RN.
  • Min 2-3 years of clinical experience in acute care or hospital set up.
  • Prior grievance and appeals or utilization management experience preferred.
  • Managed care experience.
  • Ability to work independently and follow strict state and NCQA guidelines as well as client policies.
  • Be self-driven and motivated to complete productivity requirements.
  • Good ability for reading and written English, clinical acumen and medical records review skills. 
  • Shift flexibility.

Have Questions?
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HGS is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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