Registered Nurse Case Manager

Registered Nurse Case Manager

 Job description

Third Party Administrator Provider is seeking a Registered Nurse Case Manager. Clinical experience required.

Primary Duties will include:

Use Milliman criteria used for utilization reviews

• Pre Certification Authorizations and Reviews.
• Review large medical hospital claims for accuracy and necessity.
• Telephone Communications with providers and patients.
• Review of pre-treatment notification requests.
• Concurrent Clinical review/audit of hospital admission records and charts.
• Review case history for medical necessity.

Full-Time M-F, In-Office position with excellent benefits and competitive salary for an Experienced Registered Nurse.

Job Type: Full-time

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8-hour shift

Work setting:

• Office

Education:

• Bachelor's (Required)

Experience:

• Nursing: 1 year (Required)

License/Certification:

• Registered Nurse License (Required)

Work Location: In person