Utilization Review Nurse at Green Key Resources Utilization Review Nurse at Green Key Resources in North Bergen, New Jersey Posted in 4 days ago.

Type:

full-time RN

• Utilization Management ???? 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. You'll be part of a collaborative team that includes other RN UM professionals, an Assistant Manager, Care Coordinators, and call center staff. #UtilizationManagement #RegisteredNurse #RNJobs #NursingJobs #ManagedCare #HealthInsurance #HealthcareJobs #NewYorkJobs #NYCJobs #UMRN