About this role
Role Overview
- Assist Utilization and Denials management in preparing daily operational reports
- Provide QA (quality assurance) feedback for Utilization and Denials Management specialists
- Monitor performance using key metrics for Utilization Management and Clinical Denials & Appeals
- Communicate progress across the Team to the Manager
- Mentor staff to maximize performance and potential
- Conduct monthly team meetings and annual performance evaluations
- Partner with global Operations, Training, and HR to streamline onboarding and OJL
Requirements
- At least 1 year of Utilization management and/or Clinical appeals writing QA or auditing experience in healthcare setting
- Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years of ICU experience
- Associate Degree in Nursing (ADN) or Diploma in Nursing
- Must be Registered Nurse and hold an active USRN license
- Proficiency in using InterQual or MCG clinical guidelines
- Broad Knowledge of U.S. Government Programs and Insurance Regulations
- Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- 401(k) plan with employer match
- Paid Time Off policy
- Paid parental leave
- Adoption assistance
- Free annual health screenings
- Coaching and wellness programs