
Healthcare Utilization Manager
6 days ago
As a Utilization Management Specialist, you will be responsible for assessing and interpreting customer needs, requirements, and medical records to ensure optimal outcomes.
Job Summary:
The role involves reviewing medical claims for medical necessity, evaluating data, and making informed decisions to meet business objectives.
Key Responsibilities:
- Assess customer needs, interpret medical records, and make recommendations
- Review medical claims to determine medical necessity
- Ensure compliance with laws, regulations, and company policies
- Develop strategies to improve utilization management processes
Requirements:
- Active PHRN and USRN Mainland License
- At least 1 year of bedside experience, preferably with UR/UM experience
- Excellent analytical, communication, and problem-solving skills
Working Conditions:
Work from home environment providing flexibility and autonomy.
Additional Information:
The ideal candidate will possess excellent critical thinking and problem-solving skills, with the ability to work independently and as part of a team. If you are a detail-oriented individual with strong analytical skills and a passion for healthcare, we encourage you to apply.
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