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Utilization Management Specialist II
5 days agoWhat's your preference?
Job Description
- Req#: 3743990008529546
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $60.96
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and outcomes
- Engaging role that interfaces with various medical professionals and teams
What to Expect (Job Responsibilities):
- Perform timely and accurate utilization review for all patient populations using nationally recognized care guidelines/criteria
- Communicate with case managers, physician advisors, medical team, and payers regarding reviews and pended/denied days
- Support the concurrent appeals process through proactive identification of pended/denied days
- Ensure appropriate level of care and patient status for each patient across various categories
- Review tests, procedures, and consultations for appropriate utilization of resources in a timely manner
What is Required (Qualifications):
- Licensure as a Registered Nurse or equivalent healthcare license in the state of Maryland
- Minimum of 12 months experience in case management or utilization management
- Knowledge of utilization management
- Highly effective verbal and written communication skills
- Strong analytical and team-building skills with the ability to prioritize and work independently
How to Stand Out (Preferred Qualifications):
- Experience working collaboratively with physicians and other healthcare professionals
- Familiarity with hospital/utilization management and related software programs
#HealthcareServices #UtilizationManagement #PatientCare #CareerOpportunity #NursingJobs
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