Utilization Review Nurse

RN – Utilization Management

Read on to find out what you will need to succeed in this position, including skills, qualifications, and experience.

New York, NY – Midtown

$50–$55/hour

Monday–Friday, 9:00 AM–5:00 PM

Onsite for the first 6 months, then hybrid

Temp-to-perm opportunity

A healthcare organization in Midtown Manhattan is looking for an experienced RN Utilization Management professional to join its team.

This is a great opportunity for an RN with a health insurance or managed care background and strong experience on the payer side of utilization management.

What they’re looking for:

• NYS Registered Nurse with a Bachelor’s degree
• 3+ years of Medical/Surgical nursing experience
• 2+ years of Utilization Management experience
• Strong payer-side UM experience, including medical necessity reviews, prior authorizations, appeals, and benefit determinations
• Experience with concurrent, prospective, and retrospective reviews
• Strong knowledge of Milliman Care Guidelines (MCG)
• Comfortable working with productivity metrics, turnaround times, and quality standards
• Experience collaborating with Medical Consultants on denials and clinical determinations
• Strong clinical assessment, critical thinking, and communication skills
• DMS and/or QNXT experience is a major plus

Candidates coming from health insurance or managed care organizations are especially encouraged to apply. Hospital-based UM experience may also be considered, but payer-side experience is strongly preferred. xxzpjkt

You’ll be part of a collaborative team that includes other RN UM professionals, an Assistant Manager, Care Coordinators, and call center staff.

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