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Registered Nurse / UM Manager

Posted: October 27, 2023
Salary:US$45.00 - US$57.00 per hour
Job type: Permanent
Work Location:Hybrid

Job description

At Medix, we create opportunities for qualified medical professionals through our Healthcare, Scientific, and IT divisions. Our Healthcare division is dedicated to placing you into a career growth opportunity. We are currently seeking an RN Registered Nurse with clinical nursing experience.

RN Registered Nurse - Clinical Nurse - Nursing - Healthcare - Medical

Job Responsibilities: The UM Manager is responsible for the oversight of the delegated functions of utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review including appeals and grievances related to prior authorizations and medical claim reviews The Utilization Review Nurse will work in close collaboration with Medicare Compliance Officer, Medical Director and other health plan employees on UM functions, as well as, oversight and audit functions for delegated services. The position will also play a key role in developing policies and procedures within the organization. Experience in start-up environment with desire to build the organization's sustainable and scalable operations is key to success.

Important: This position is remote but may require the talent to go onsite 1 day/week down the line.

3-5 Must Have Skills/Qualifications
  • MAssachusetts RN License
  • 2 years of experience in acute care clinical nursing, to include working in high-acuity settings such as Med/Surg, ICU, Step-Down, ED/ER, OR.
  • 2 years of experience at a Medicare Advantage health plan or other Managed Care Organization, HMO, TPA, IPA.
  • Experience using MCG/Milliman/InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Experience with Microsoft Office

Schedule: M-F 8am-5pm with 1 hour lunch

RN Registered Nurse - Clinical Nurse - Nursing - Healthcare - Medical

Medix - Positively impacting lives every day!

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