Similar Jobs
See allRN Care Manager
Capital Blue Cross
US
Communication
Critical Thinking
Problem-solving
RN, Utilization Management
Oregon Health & Science University
US
Utilization Review
Negotiating
Clinical
Medical Director (Utilization Management)
HJ Staffing
Managed Care
CMS
Medicare Advantage
Utilization Review Nurse
NeuroPsychiatric Hospitals
US
Utilization Review
Case Management
Patient Care
Clinical Risk Manager
Berkley Accident & Health
US
Risk Management
Medical Coding
Microsoft Office
Responsibilities:
- Processes requests through review of clinical records.
- Applies approved medical necessity criteria.
- Complies with confidentiality policies.
Skills:
- Ability to think critically and problem solve.
- Ability to prioritize multiple tasks.
- Ability to communicate clearly.
Experience:
- 5 years’ experience in a higher level of care clinical role required.
- 1 year UM experience in managed care required.
Education and Certifications:
- Must have active Registered Nurse licensure in Pennsylvania.
- Requires Certified Case Manager (CCM) certification or the ability to obtain within 2 years.
Capital Blue Cross
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. At Capital, employees work alongside a caring team of supportive colleagues and are encouraged to volunteer in their community.