About this opportunity
Green Key Resources lists this Utilization Review Nurse opportunity in new york city (brooklyn), New York. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.