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Job description
Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN to manage Utilization Management medical appeal cases, ensuring timeliness and compliance with NCQA, URAC and NJ/Federal regulations. The role includes mentoring and clinical liaison support to appeals staff and involvement in special management projects.
The position requires evaluating care against guidelines, reviewing records, presenting to Appeals Committee with coordination with independent URO, and providing 24/7
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.