Utilization Management Professional

Brooklyn, United StatesOn-SiteFull-timePosted 4w ago

All Integrated Resources INC jobs

Job description

Under general supervision, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services.

Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information.

Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.

lpn or rn

associate degree

Caseload: 15-20 reviews per day which could be telephonic or via fax. The member population is mostly geriatric who reside in sub-acute nursing facilities.

To be successful, the selected candidate must be comfortable working in a fast pace environment, documenting electronically, making ethically sound judgement, have strong organization, time management and communication skills and be a team player.

Training: Is 4 – 6 weeks long weeks

Participates in Care Coordination Team and utilization management activities, including collaboration with other staff on enrollee cases, and performing data collection, tracking, and analysis.- Maintains an active work load in accordance with performance standards.

Works with community agencies as appropriate.- Advocates for the enrollee to ensure health care needs are met. Interacts with providers in a professional, respectful manner.

Job details are sourced from the employer's original posting.

Open job posting

About the company

Integrated Resources INC

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

View all Integrated Resources INC jobs

Industry: Staffing
Founded: 1996
Open roles: 2471