Utilization Review Nurse

Provide Utilization Review experience, managerial leadership and oversight. Requires active Pennsylvania nursing license, using criteria sets and a history of five years experience in the review process. Must have a strong knowledge of coding and claims review experience as well as strong computer skills, particularly in Microsoft Office.

Will be assigned to a Medicare work group and project team, consisting of on-going process responsibilities and work group participation. Consult with senior staff to outline and improve major operational issues. Act as a liason between departments. Help develop in-house training materials and programs relating to claims review processing. Assist in determining necessary changes relating to criteria or regulations to better serve clients. Interface with Providers with billing and claims issues. Positions in Harrisburg and Pittsburgh.

Pleasant office environment. The CK Hobbie Group is a fifty-six year old recruiting and staffing business