RN Case Manager: Care Coordination & Payer Liaison
The CORE Institute
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Benefits offered by this job
Job summary
The CORE Institute in Phoenix, Arizona, is seeking a qualified Registered Nurse with experience in case management. You will conduct medical record reviews, collaborate with healthcare providers, and manage pre-authorizations and clinical appeals.
Candidates must have an Associate Degree in Nursing, with a preference for a Bachelor of Science in Nursing. Strong clinical skills and experience in a high-stress environment are essential. Join our team and contribute to delivering quality patient care.
Qualifications
- Must have a current and unrestricted Arizona Registered Nurse (RN) license.
- Certification in Health Care Quality Management or as a Certified Case Manager preferred.
- Experience in direct patient care within an acute care hospital required.
- Three to five years of clinical experience in case management or utilization management required.
Responsibilities
- Conduct concurrent and retrospective reviews of patient medical records.
- Issue pre-authorizations for procedures and medications to insurance carriers.
- Collaborate with physicians to discuss patient care plans.
- Track and analyze utilization data for reporting purposes.
- Prepare and submit clinical appeals to insurance companies.
Skills
Education
Job description
The CORE Institute in Phoenix, Arizona, is seeking a qualified Registered Nurse with experience in case management. You will conduct medical record reviews, collaborate with healthcare providers, and manage pre-authorizations and clinical appeals.
Candidates must have an Associate Degree in Nursing, with a preference for a Bachelor of Science in Nursing. Strong clinical skills and experience in a high-stress environment are essential. Join our team and contribute to delivering quality patient care.
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