Job Opportunities in United States
November 7, 2024
Walker Healthforce, LLC
CONTRACT
Utilization Management RN | Remote | Contract
Utilization Management RN | Remote | Contract
Walker Healthforce is seeking a Utilization Management Registered Nurse for a healthcare client located remotely. This is a contract opportunity.
Eligible candidates must be local to one of the following states: NJ, NY, PA, DE or CT.
Start Date: ASAP
Walker Healthforce Standard Perks:
JOB DESCRIPTION
JOB REQUIREMENTS
PREFERRED JOB REQUIREMENTS
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1
Walker Healthforce is seeking a Utilization Management Registered Nurse for a healthcare client located remotely. This is a contract opportunity.
Eligible candidates must be local to one of the following states: NJ, NY, PA, DE or CT.
Start Date: ASAP
Walker Healthforce Standard Perks:
- Weekly pay via Direct Deposit
- Medical, Dental, and Vision Available
- 401K
JOB DESCRIPTION
- Review and investigate Level 2 Commercial Appeals.
- Assess and analyze UM denial reasons and appeal requests.
- Make sound clinical judgments based on appeal reviews, adhering to regulations and clinical guidelines.
- Present clinical findings and recommendations to committees.
- Navigate multiple systems efficiently to maintain turnaround times.
JOB REQUIREMENTS
- Associates Degree
- Must type 100 words per minute
-
3 - 5 years of experience with a background in either of the following:
- Utilization Management
- Prior Authorization – Medical Surgical (Inpatient or Outpatient)
- Complex Case Management w/ exposure to UM, Concurrent
- Retrospective Medical Policy Review
- Unrestricted Compact RN License
- Proficient in UM policies and clinical guidelines
- Proficient in Microsoft programs (Care Radius, Excel, One Note, Outlook, Teams, Word, etc.)
PREFERRED JOB REQUIREMENTS
- Bachelor's Degree
- Utilization Review Certification
- Familiarity with UM Pharmacy appeals
- Health Insurance Payer experience
- Familiarity interpreting Milliman Care Guidelines MCG guidelines
- Care Radius platform exposure
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1
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