Utilization Management Nurse

Major Duties and Responsibilities Responsible for coordinating cases for precertification and prior authorization review. Manages incoming calls, including triage, opening of cases and authorizing sessions. Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate. Responds to telephone and written inquiries from clients, providers and in‑house departments. Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks benefits for facility based treatment. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Qualifications EDUCATION / EXPERIENCE High school diploma or equivalent. Minimum of 2 years of customer service call‑center experience is required. Experience in medical or insurance field strongly preferred. PC proficiency. #J-18808-Ljbffr