Job Details

A company is looking for a RN Managed Care Coordinator I (Utilization Management).Key ResponsibilitiesPerform medical or behavioral review/authorization processes to ensure service coverage meets eligibility and medical necessity guidelinesUtilize resources to support review determinations and coordinate referrals to appropriate staff while ensuring compliance with regulatory guidelinesProvide education to members and providers about the healthcare delivery system and promote enrollment in care management programsRequired QualificationsAssociates degree in a job-related field or equivalent experienceTwo years of clinical experienceActive, unrestricted RN licensure or equivalent licensure in social work or counselingWorking knowledge of word processing software and Microsoft OfficeAbility to work independently and prioritize effectively