RN Utilization Management Reviewer
Sagility(7 months ago)
About this role
The RN Utilization Management Reviewer at Sagility is responsible for conducting timely clinical and service authorization reviews to ensure compliance with CMS standards. This role involves assessing medical necessity for various services, interpreting clinical criteria, and effectively communicating decisions to healthcare teams and stakeholders.
Required Skills
- Clinical Decision Review
- CMS Compliance
- Medical Necessity
- Documentation
- Communication
Qualifications
- RN - Associate’s Degree
- RN License in Massachusetts
- CCM - Certified Case Manager
About Sagility
sagilityhealth.comSagility delivers end-to-end healthcare BPO, revenue cycle management, and clinical support services for providers and payers. Explore our full-service model.
View more jobs at Sagility →Apply instantly with AI
Let ApplyBlast auto-apply to jobs like this for you. Save hours on applications and land your dream job faster.
More jobs at Sagility
Similar Jobs
RN - Utilization Reviewer - Coordinated Care - PT
University of Mississippi Medical Center(1 month ago)
RN Utilization Management Reviewer
Blue Cross Blue Shield of Massachusetts(4 months ago)
Staff Utilization Management Clinical Pharmacist (VSP/PT)
Humana(1 month ago)
Medical Reviewer (Medicare)
Broadway Ventures(1 month ago)
RN Utilization Management Reviewer
Blue Cross Blue Shield of Massachusetts(21 days ago)
RN-Utilization Review (S)
SSM Health(28 days ago)