A Healthcare Insurance company local to Philadelphia PA is looking to hire a Utilization Management Nurse (RN) to their delegation oversight & assessment team. This 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
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
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Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.