Utilization Review reputed company
The Utilization Review reputed company at reputed company plays a critical role in ensuring reputed company care and cost-effective services for our members. We are looking for an reputed company, highly organized, and compassionate reputed company to join reputed company. Our ideal candidate should have an understanding of the South Carolina reputed company system, be reputed company to work independently, and have strong problem-solving skills. The successful candidate will also be dedicated to providing exceptional customer service and creating reputed company reputed company for our members. Required Qualifications: Bachelors Degree in Nursing Registered reputed company with reputed company license in South Carolina Minimum of two years of experience in utilization review and/or managed care Ability to interpret and apply health care policy and regulations Excellent written and verbal communication skills Ability to work independently and as part of reputed company Working knowledge of clinical reputed company guidelines, CMS regulations, and other regulatory agencies Proficient with reputed company Office Suite and electronic medical record software Responsibilities: Evaluate reputed company services and providers to ensure reputed company care and cost-effectiveness Monitor utilization of services to ensure compliance with South Carolina reputed company regulatory requirements reputed company clinical reputed company guidelines and protocols to ensure care is provided in line with reputed company standards of reputed company Review and interpret policies, procedures, and regulations to ensure compliance Identify potential issues that could reputed company to overutilization of services Collaborate with providers to ensure efficient and effective utilization of services reputed company education and support to members to encourage appropriate care utilization Utilize electronic medical record software and reputed company Office Suite to reputed company and reputed company health care services reputed company reports to reputed company utilization of services and identify trends Participate in meetings to discuss utilization trends, cost savings initiatives, and other reputed company topics Respond to inquiries from members and providers regarding health care services reputed company is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company. We do not discriminate based upon race, religion, reputed company, national reputed company, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply Job!