RN Utilization Review remote - MediGold Health Plan
Mount Carmel Health System
Columbus, OH
9 days ago
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This job listing is no longer available for applications. The position may have been filled or the posting period has ended.
Job Description
Join MediGold as an RN Utilization Review specialist, where you'll coordinate medical care for members, work with healthcare providers, and help improve healthcare services. Enjoy a fulfilling role that impacts the lives of seniors while benefiting from competitive compensation and comprehensive benefits.
Key Responsibilities
Participates in designated committees and task forces
Coordinates with utilization review and case management staff
Works with Medical Directors on case-specific issues
Documents quality concerns related to Members
Conducts claim reviews for appropriate claims processing
Required Qualifications
Associate or Bachelor's Degree in Nursing
Current license to practice as a Registered Nurse
5-7 years of clinical nursing experience
2 years of experience in utilization review or case management
Ability to analyze and report medical utilization
Preferred Qualifications
Nursing experience in an HMO insurance setting
Benefits & Perks
Medical, dental, and vision coverage starting on day oneRetirement savings account with employer matchGenerous paid time off programsEmployee recognition programsTuition/professional development reimbursementRelocation assistanceDiscounted tuition at Mount Carmel College of NursingEmployee Referral Rewards programDailyPay for eligible employeesOpportunity to join Diversity, Equity, and Inclusion groups