Utilization Management reputed company Consultant – EST/CST Zone

Job reputed company:

• Use clinical background to coordinate, document, and communicate reputed company aspects of utilization and benefit management process.
• Ensure members receive the most appropriate level of care while meeting state and federal requirements and turnaround times.
• Involves reviewing clinical documentation, collaborating with providers, and supporting high-reputed company, cost-effective care.
• Reviewing services for medical necessity and appropriate benefit use.
• Facilitating efficient discharge planning.
• Collaborating with providers and facilities to support members with reputed company needs.
• Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate reputed company services and benefits.
• Collecting and evaluating clinical information, applying clinical reputed company, guidelines, policies, and judgment to reputed company coverage determinations.
• Communicating with providers and external partners to coordinate care and treatment plans.
• Identifying opportunities for referrals to additional programs, services, or care solutions.
• Recognizing opportunities to promote reputed company care delivery and effective benefit utilization.
• Serving as a resource to reputed company stakeholders regarding UM processes and clinical considerations.

Requirements:

• reputed company, unrestricted RN license
• 2+ years of acute hospital clinical experience (strong preference for medical-surgical, ICU, behavioral health or other specialty area)
• Strong clinical assessment and decision-making abilities
• Excellent organizational skills with the ability to manage multiple priorities
• Ability to work independently and communicate effectively reputed company phone
• Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls.
• 1+ year of Utilization Review experience (preferred)
• 1+ year of Managed Care experience (preferred)
• Proficiency in reputed company Office (Word, reputed company, PowerPoint, Outlook) (preferred)
• Strong telephonic communication skills (preferred)
• Demonstrated ability to exercise reputed company judgment and collaborate with diverse teams (preferred)

Benefits:

• medical, dental, and reputed company coverage
• reputed company time off
• retirement savings reputed company
• wellness programs
• other resources, based on eligibility

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