Actalent Remote Utilization Management Nurse in Chattanooga, Tennessee
Actalent is currently partnering with a large company in the Chattanooga area in need of a Remote Utilization Management RN to join their team. They are only considering candidates that reside in the state of Tennessee. Please see below for details and qualifications!
Reviewing cases for members on a daily basis to deem if they are qualified for insurance coverage
Performs comprehensive pre-existing reviews, reviews of rider-related diagnoses, potential misrepresentation referrals, rider related drug appeals, provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, nursing judgement, and contractual eligibility for Medicare Med Advantage members
Performs thorough research and provides complete documentation for rationale to support determinations as well as specific written instructions regarding additional information necessary to complete the review
Additional Skills & Qualifications:
2+ years Utilization Management Utilization Review required
Compact RN license required
Bachelor of Science in Nursing preferred
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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