Utilization Management Nurse Coordinator

aoncology; Macon (GA); On-site; USD 41,000 - 61,000; Full time

Job summary

Central Georgia Cancer Care is seeking a Clinical Utilization Management Coordinator to ensure treatment plans align with payer policies and approvals. The role involves reviewing patient files, obtaining pre-authorizations, and communicating payer positions to care teams to safeguard medical necessity.

Responsibilities include concurrent and precertification reviews, coordinating with payers, updating physicians, and maintaining compliant documentation in a fast-paced oncology setting.

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.
• State Licensure as a Licensed Practice Nurse (LPN) or Registered Nurse (RN); UM or Case Management certification preferred.
• Excellent interpersonal and communication skills; detail-oriented and self-starter.

Responsibilities

• Conduct concurrent review to maintain active pre-authorizations for scheduled treatments.
• Review precertification and authorization requests for medical necessity.
• Communicate with payer plans regarding authorization requirements and determinations.
• Provide timely updates to physicians and clinical teams on authorization status.
• Maintain accurate documentation of all pre-authorizations and payer communications.
• Advocate for timely, high-quality patient care aligned with payer guidelines.

Skills

Communication

Organization

Collaboration

Documentation

Analysis

Advocacy

Education

LPN or RN licensure

Job description

Central Georgia Cancer Care is seeking a Clinical Utilization Management Coordinator to ensure treatment plans align with payer policies and approvals. The role involves reviewing patient files, obtaining pre-authorizations, and communicating payer positions to care teams to safeguard medical necessity.

Responsibilities include concurrent and precertification reviews, coordinating with payers, updating physicians, and maintaining compliant documentation in a fast-paced oncology setting.