ASSOCIATE UTILIZATION ANALYST/RN

Be the voice of expertise and efficiency for the medical review and determination of claims matters. In this role, you will evaluate claims documentation, determine coverage eligibility, establish provider or beneficiary liability, make decisions to approve or deny payment, and further review appeals. Beyond your key role in assessing and processing claims, you will serve as a strong medical resource to the staff and other departments—especially when it comes to training related to applying guidelines, new industry developments, and HCFA/HCQA procedures. Position also involves conducting analysis of data and trends in provider non-compliance, performance, and [fraudulent] billing practices, then formulating reports and recommendations for improvement. To qualify you must have: Valid current New Jersey RN license. Two + years of clinical experience. Direct experience in chart review (within a physician office or insurance company environment). Broad knowledge of the following is preferred: Managed care principles, utilization review, healthcare contracts, benefits eligibility, medical terminology, claims and pre-existing condition reviews. Excellent analytical, organizational, interpersonal, communication and computer skills are required.We offer highly competitive salaries, a dynamic work environment, and a comprehensive benefits package that includes an on-site fitness and day care centers.