New Jersey Licensed Utilization Analyst - Denver Colorado

Company: VirtualVocations
Location: Denver, Colorado
Posted On: 01/30/2025

A company is looking for an Associate Utilization Analyst to review medical documentation for accurate clinical determinations.



Key Responsibilities

Review professional medical claims policy issues and claims in pending status
Make clinical determinations based on reviews and relevant guidelines
Prepare cases for internal and external review and respond to inquiries from Claim Policy teams


Required Qualifications, Training, and Education

High School Diploma or GED required; BSN preferred
Must have a NJ State Registered Nurse License or MD (non-board certified accepted if certified abroad)
Preferred minimum of 3 years clinical experience
Preferred minimum of 3 years business/insurance experience
Preferred certification in medical coding More...

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