Utilization Management US RN Sr Analyst

Grievance & Appeals

• Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
• Creates a detailed case summary in narrative format for each appeal.
• Submits cases as directed for each applicable geographic region.
• Presents verbal and written case summaries to client’s Grievance Team and client Medical Directors.
• Completes assignments within client-designated turnaround times.
• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• 3 months clinical experience (480 hours of working experience as a RN)
• Work experience as an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or community clinic
• No state license required
• For CL 10 role USRN + UM, minimum 6 months of UM experience.
• Work experience such as TL, QA, Trainer and Claims are preferred and good to have skills only.