RN: Utilization Management & Care Coordination Leader

Health One Alliance, LLC; Dalton (GA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

401K (4% Match, Immediate Vesting)

Medical Insurance

Paid Time Off

Life & AD&D Insurance

Job summary

Health One Alliance, LLC is seeking a Utilization Management Nurse to perform clinical reviews and ensure quality patient care. The role involves coordinating care referrals and reviewing claims while adhering to HIPAA regulations.

The candidate should have significant clinical experience and a current RN license. Benefits include competitive salary, various insurance options, and a matching 401K plan.

Qualifications

• 3 years of clinical experience preferred.
• 1-2 years of utilization review preferred.
• Adaptive to high pace and changing environment.

Responsibilities

• Perform comprehensive clinical reviews of requested services.
• Initiate referrals to ensure appropriate coordination of care.
• Assist non-clinical staff in administrative reviews.

Skills

Clinical experience

Utilization Review

Proficiency in Microsoft Office

Customer service orientation

Interpreting medical policy

Education

Current, active Compact State license in Nursing (RN)

Job description

Health One Alliance, LLC is seeking a Utilization Management Nurse to perform clinical reviews and ensure quality patient care. The role involves coordinating care referrals and reviewing claims while adhering to HIPAA regulations.

The candidate should have significant clinical experience and a current RN license. Benefits include competitive salary, various insurance options, and a matching 401K plan.