
Senior Utilization Management Specialist
2 days ago
We are seeking an experienced Utilization Management professional to join our team.
Job Description:The role involves assessing and interpreting customer needs, requirements, and medical records to ensure accurate and up-to-date information.
You will review medical claims for medical necessity, ensuring that all information is correct. This position requires strong analytical and communication skills.
Key Responsibilities:
- Assess and interpret customer needs, requirements, and medical records
- Review medical claims for medical necessity
- Ensure accuracy and completeness of all information
- Communicate effectively with customers, clinicians, and other stakeholders
Qualifications:
- Active PHRN and USRN Mainland License
- 1 year Bedside experience, preferably with UR/UM experience
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