Utilization Mgmt Nurse: Authorization & Care Coordination

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

Job summary

Central Georgia Cancer Care is seeking a Clinical Utilization Management Coordinator to ensure quality, cost-efficient care with payer pre-authorization. You will review patient treatment files, verify medical necessity, and communicate payer determinations to the clinical team.

Requirements include RN or LPN licensure, 2+ years in utilization management (oncology preferred), and strong communication, organization, and documentation skills.

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 authorizations.
• Excellent interpersonal and communication skills, be very detail-oriented and a self-starter.

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.
• Communicate with payer plans regarding authorization requirements, coverage determinations, and treatment-related approvals.

Skills

Communication

Organization

Collaboration

Documentation

Analysis

Advocacy

Education

RN or LPN licensure

Job description

Central Georgia Cancer Care is seeking a Clinical Utilization Management Coordinator to ensure quality, cost-efficient care with payer pre-authorization. You will review patient treatment files, verify medical necessity, and communicate payer determinations to the clinical team.

Requirements include RN or LPN licensure, 2+ years in utilization management (oncology preferred), and strong communication, organization, and documentation skills.