Utilization Review Nurse
Job Code : HGS/311ROSWELL |GA Permanent
Customer Service Representative – Utilization Review Nurse (HGS/311)
The primary role of the Utilization Review Nurse is to utilize 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. If you are analytical, detail-oriented, and enjoy solving problems both imaginatively and resourcefully; consider a career with us today!
What do we offer?
· $32.00/hour in a full-time role
· Full-time hours (you will average 40 hours per week)
· A Real opportunity to grow your career
90% of our Managers staff started their career as a Customer Service Representative
What are we looking for?
· High School Diploma or GED
· 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
· 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 skill
· The ability to work Monday thru Friday 8am to 4:30pm schedule
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.