Clinical Utilization Manager (RN/LPN) - Flexible Schedule

American Oncology Management Company; Macon (GA); On-site; USD 42,000 - 61,000; Full time

Benefits offered by this job

Ergonomic seating

Flexible schedules

Accessible workstations

Screen reader software

Job summary

Central Georgia Cancer Care in Georgia is seeking a Clinical Utilization Management Coordinator to ensure that cancer treatments are administered with quality and payer compliance. The role involves reviewing patient files for pre-authorization and communicating payer positions on medical necessity.

The ideal candidate is an RN or LPN with experience in utilization management, strong communication skills, and the ability to coordinate with providers, payers, and clinical teams in a fast-paced

Qualifications

• Graduate of an accredited nursing program with current LPN or RN licensure.
• Two years LPN or RN experience; oncology preferred.
• Two years experience in utilization management and obtaining insurance authorizations in a medical setting.

Responsibilities

• Conduct concurrent review of patient clinical information to ensure active pre-authorization is maintained for scheduled treatments and procedures.
• Review precertification and authorization requests for medical necessity and verify that required approvals are in place prior to treatment delivery.
• Monitor new treatment plans, treatment changes, and other clinical activities that may impact existing authorizations or require additional payer approval.
• Apply clinical knowledge, critical thinking, and independent judgment when reviewing authorization requirements and resolving payer-related issues.
• Provide timely updates to physicians, clinical teams, and other healthcare providers regarding authorization status, outstanding requirements, and payer determinations.

Skills

Communication

Organization

Collaboration

Documentation

Analysis

Advocacy

Education

LPN or RN licensure

Job description

Central Georgia Cancer Care in Georgia is seeking a Clinical Utilization Management Coordinator to ensure that cancer treatments are administered with quality and payer compliance. The role involves reviewing patient files for pre-authorization and communicating payer positions on medical necessity.

The ideal candidate is an RN or LPN with experience in utilization management, strong communication skills, and the ability to coordinate with providers, payers, and clinical teams in a fast-paced