More jobs:
UM Appeals Resolution RN; Analyst II
Job in
Clifton, Passaic County, New Jersey, 07015, USA
Listed on 2026-09-01
Listing for:
Horizon Blue Cross Blue Shield
Full Time
position Listed on 2026-09-01
Job specializations:
-
Management
Healthcare Management
Job Description & How to Apply Below
Horizon Blue Cross Blue Shield of New Jersey is seeking a focused Utilization Management Appeals RN to ensure medical necessity and timely handling of appeal cases. You will mentor staff, coordinate with legal, and review records to support regulatory compliance across NCQA, URAC and NJ/Federal requirements.
Responsibilities include presenting to the Appeals Committee, guiding vendors, and ensuring cost-effective patient care while maintaining high-quality outcomes.
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