Utilization Management Coordinator - Registered Nurse (RN)
Posted on: February 20, 2021
This position is responsible performing initial, concurrent review
activities; discharge care coordination for determining efficiency,
effectiveness and quality of medical/surgical services and serving
as liaison between providers and Medical and Network Management
Divisions. This position reviews service requests, collects
clinical and non-clinical data, verifies eligibility, determines
benefit levels in accordance to contract guidelines, prepares
reports on quality of care, identifies and reports cases, and
provides information regarding utilization management requirements
and operational procedures to members, providers and facilities.
This position will be engaged with Utilization Management
*Registered Nurse (RN) with valid, current, unrestricted license in
The State of New Mexico.
*3 years of clinical experience in a physician office,
hospital/surgical setting or health care insurance company.
*Knowledge of medical terminology and procedures.
*Verbal and written communication skills.
*Willingness and ability to travel, on a rare occasion, if
PREFERRED JOB REQUIREMENTS:
* 2+ years of Utilization Management experience is preferred.
* 3 years of clinical experience in various environments including:
acute hospital setting, physician office, LTACH/SNF, home health,
surgical setting or health care insurance company.
* In-patient nursing experience.
* Specialty RN experience - Oncology, NICU, O/R, Cardio, etc. - a
variety of clinical experience is preferred - NOT limited to NICU
or Maternal Health
* Intensive Care and/or Critical Care experience is preferred.
* Case Management, Care Management, Condition Management and/or
Disease Management experience is a plus.
* MCG Certification is a plus.
HCSC is committed to diversity in the workplace and to providing
equal opportunity and affirmative action to employees and
applicants. We are an Equal Opportunity Employment / Affirmative
Action employer dedicated to workforce diversity and a drug-free
and smoke-free workplace. Drug screening and background
investigation are required, as allowed by law. All qualified
applicants will receive consideration for employment without regard
to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or protected veteran status.
Expertise Nursing Job Type Full-Time Regular Location NM -
AlbuquerquePandoLogic. Keywords: Utilization Review Coordinator,
Location: Albuquerque, NM - 87131
Keywords: HCSC, Albuquerque , Utilization Management Coordinator - Registered Nurse (RN), Executive , Albuquerque, New Mexico
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