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Utilization Management RN (7176)

Company: The Judge Group
Location: Chattanooga
Posted on: February 15, 2020

Job Description:

Judge healthcare is currently seeking a Utilization Management RN (7176) in the Chattanooga area.-- This job will have the following responsibilities: Performs comprehensive pre-existing reviews, reviews of rider-related diagnoses, potential misrepresentation referrals, rider related drug appeals, provider and member appeals, denial interpretation for letters, retrospective claim review.--Performs thorough research and provides complete documentation for supporting decisions.Performs or participates in special studies.-- Qualifications & Requirements: Registered Nurse in the state of Tennessee (State or Compact Licensure required)Bachelor's degree in nursing preferredMinimum 3 years of varied clinical experience required (w/ recent experience in either Utilization--Management--or Case Management)Proficient knowledge and ability to apply various accreditation requirements (URAC, NCQA, etc.) preferred.

Keywords: The Judge Group, Chattanooga , Utilization Management RN (7176), Healthcare , Chattanooga, Tennessee

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