Utilization Management Nurse - job 2 of 3

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Establish and maintain relationships with healthcare providers, payers, and clients in a telephonic setting
• Serve as an expert on prior authorization, denials, and payer requirements for drug insurance coverage
• Advocate for patients regarding eligibility, program enrollment, reimbursement, and access to prescribed therapy

Required Qualifications

• AD or Bachelor's Degree in Nursing (BSN, RN) with a valid nursing license in one or more states
• Four or more years of nursing experience; telephonic experience is a plus
• Knowledge of medical insurance terminology and healthcare billing is preferred
• Experience with digital CRM systems is required
• Proficient with Microsoft products