Registered Nurse Utilization Management

Cognizant Technology Solutions Corporation; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare consultancy is seeking a Clinical Registered Nurse for Utilization Management in a remote role. The successful candidate will manage clinical denials, document claims accurately, and identify denial patterns. Candidates should have an RN educational background and 2-3 years of relevant experience in utilization management and healthcare operations. Intermediate Microsoft Office skills are also essential.

Qualifications

• 2-3 years of clinical and/or utilization management experience with managed health care plans.
• 3 years of experience in health care revenue cycle or clinic operations.
• Experience in utilization management, including clinical appeals and precertification.

Responsibilities

• Manage clinical denials and perform medical necessity reviews based on various guidelines.
• Document claims and appeals information accurately in tracking systems.
• Identify denial patterns and escalate potential risks to stakeholders.

Skills

Medical necessity reviews

Utilization management

Intermediate knowledge of Microsoft Office

Education

Registered Nurse (RN) educational background

Job description

A company is looking for a Clinical Registered Nurse - Utilization Management - Remote.

Key Responsibilities

• Manage clinical denials and perform medical necessity reviews based on various guidelines
• Document claims and appeals information accurately in tracking systems
• Identify denial patterns and escalate potential risks to stakeholders

Required Qualifications

• Registered Nurse (RN) educational background
• 2-3 years of clinical and/or utilization management experience with managed health care plans
• 3 years of experience in health care revenue cycle or clinic operations
• Experience in utilization management, including clinical appeals and precertification
• Intermediate knowledge of Microsoft Office (Excel, Word, Outlook)