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Health Care Service Corporation ยท 2 days ago
Utilization Management Coordinator - RN
Albuquerque, NM
Full-time
Onsite
Mid Level
3+ years exp
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Responsibilities
Performing initial and concurrent review activities.
Coordinating discharge care to determine efficiency, effectiveness, and quality of medical/surgical services.
Serving as a liaison between providers and Medical and Network Management Divisions.
Reviewing service requests, collecting clinical and non-clinical data, verifying eligibility, and determining benefit levels in accordance with contract guidelines.
Preparing reports on quality of care, identifying and reporting cases, and providing information regarding utilization management requirements and operational procedures to members, providers, and facilities.
Qualification
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Required
Registered Nurse (RN) with valid, current, unrestricted license in the state of operations (New Mexico).
3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
Knowledge of medical terminology and procedures.
Verbal and written communication skills.
Preferred
Utilization management experience.
MCG Certification.
Benefits
Relocation assistance will not be provided
Company
Health Care Service Corporation
Health Care Service Corporation is a customer-owned health insurance company.
10,001+ employees
Funding
Current Stage
Late StageLeadership Team
Manika Turnbull
Senior Vice President & Chief Human Resources Officer
Recent News
PRNewswire
2024-05-19
Company data provided by crunchbase
