Utilization Management: Clinical Claims Nurse

Overview

Required skills & experience (the 5 “must haves” to be considered) 1. Active, unrestricted RN (BSN preferred) license 2. Five years healthcare experience (including at least 2 years clinical practice in an acute care setting, i.e., ER or hospital) 3. Two years utilization review experience at a managed care plan or provider organization 4. Two years of coding experience, certified (preferred) 5. Must have UR, but also understand payment integrity What you need to know • Primary responsibility in this role will be to conduct initial assessments of medical necessity for inpatient and outpatient services • You will also interact with providers, members, and internal service team to obtain necessary information and communicate approval determinations • Be part of a fast growing department within a rapidly growing startup • Great company culture, benefits and unlimited PTO

Benefits

Company

Healthcare is broken; we're trying to fix it. Our team is focused on utilizing technology, design and data to humanize healthcare. We're a group of technology and healthcare professionals who looked at the current state of the US healthcare system, got frustrated by the horrible consumer experience, and decided to do something big about it. Backed by a renowned set of investors and advisors, we’ve set out to revolutionize healthcare.