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Utilization Management Nurse at HealthOne Alliance - ApplyBlast

Utilization Management Nurse

HealthOne Alliance

3 months ago

3.7 on Glassdoor

Dalton, Georgia, United States

Onsite

Full Time

Medior

0 applicants

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About this role

The Utilization Management Nurse conducts comprehensive clinical reviews of requested services, ensuring appropriate coordination of care and adherence to medical criteria. The role involves handling appeals, denials, retrospective claim reviews, and pre-certifications while maintaining compliance with HIPAA and company policies.

Responsibilities

Perform comprehensive clinical utilization reviews
Initiate referrals and coordinate care
Interpret benefits and medical policy for appeals

Skills

Qualifications

Current, active Compact State RN license

About HealthOne Alliance

healthonellc.com

Headquarters

Dalton, Georgia, United States

Company Size

51-200 employees

View Profile

HealthOne Alliance is a community-focused healthcare organization owned and governed by local health care providers. The company works directly with industry to support managed group health benefit plans and network needs. HealthOne's mission is to return healthcare decision-making to the community, keeping physicians and patients in control of their medical care.