Utilization Review Nurse/Healthcare Advocate (LPN/RN)
Physicians Plus Insurance Corporation - Madison, WI

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Physicians Plus Insurance Corporation has a full-time Utilization Review Nurse/Healthcare Advocate opportunity available within our Health Services Department. The purpose of this position is to monitor, evaluate and make determinations regarding medical necessity, appropriateness, utilization, cost-effectiveness and quality of inpatient/outpatient healthcare services for Physicians Plus members. Also assists in the education of members and healthcare providers regarding coverage/benefits and administrative policies.

The qualified applicant will be an RN or LPN licensed in Wisconsin with a minimum of 2-4 years of well-rounded clinical nursing experience. BS in Nursing and 1+ year of managed care/utilization review experience are preferred. Excellent problem solving, organizational, time management, interpersonal and written and verbal communication skills are required. The ideal applicant will be customer oriented and work well independently and with the Health Services team. Proficiency in MS Excel, Word and Outlook is required. Claims processing system and/or McKesson CCMS experience is preferred.

Physicians Plus Insurance Corporation - 20 months ago - save job - block
About this company
Physicians Plus Insurance Corporation of Madison, Wisconsin, is a nationally recognized managed care organization focused on providing...