What are the responsibilities and job description for the Utilization Management Nurse position at Insight Global?
Insight Global Health is searching for multiple Utilization Review / Utilization Management nurses to join our growing team in Camden, NJ. This team currently works hybrid.
Requirements :
- Active NJ RN license
- Minimum 1 year of experience working in Utilization Review or Utilization Management with commercial payers or medicare / medicaid
- Knowledge of commercial payer plans is a must, government plans a plus
- High proficiency operating in multiple computer systems daily
- Extreme attention to detail
This UR / UM team is currently working with all case files for commercial and government payer patients. Nurses can expect to perform in depth audits of vendors such as Magellan, Cigna, Epicor, and more payers. Through audit performance, this team ensures that payers and providers adhere to all state and federal regulatory requirements while also ensuring that files / claims are not denied throughout the payment process. This team sits on the front end of claim submission to government and commercial payers. Nurses will begin on the commercial team as they learn the government payer side. Government payer team manages 10 - 25 case files per month. Commercial payer team manages 4 - 5 case files per month.
Schedule is Monday through Friday, 8 AM - 5 PM or 9 AM - 5 PM.
