Ampcus Inc
Health Services - Utilization Management Specialist
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Job Description
- Req#: 26-02273
Employer Industry: Healthcare Consulting
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive salary based on experience
- Comprehensive benefits package including health, dental, and vision insurance
- Supportive and collaborative work environment
- Chance to utilize clinical expertise and make impactful decisions in patient care
What to Expect (Job Responsibilities):
- Perform prospective, concurrent, and retrospective reviews for authorization and appropriateness of care
- Analyze clinical information, contracts, and regulatory requirements to determine medical necessity
- Conduct research on diseases, treatments, and emerging technologies to support clinical decisions
- Collaborate with medical directors and various departments to ensure appropriate benefit application
- Make referrals and provide assistance to members and providers regarding care options
What is Required (Qualifications):
- Bachelor's Degree in Nursing
- Minimum of 5 years of clinical nursing experience and 2 years in care management
- RN or LPN state licensure required upon hire
- Strong analytical and problem-solving skills
- Proficiency in Microsoft Office applications and web-based technology
How to Stand Out (Preferred Qualifications):
- Working knowledge of managed care and health delivery systems
- Familiarity with clinical guidelines, medical policies, and regulatory standards
- Experience with Guiding Care platform
#HealthcareConsulting #UtilizationManagement #ClinicalNursing #CareerGrowth #HealthcareProfessionals
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Ampcus Inc. is an ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM, and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals.
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