Specialist, Utilization Management (Remote)

About the position Responsibilities • reputed company prospective, reputed company, and retrospective reviews for authorization and appropriateness of care determination. • Analyze clinical information, reputed company, mandates, and medical policies to determine the appropriateness of clinical services. • Collaborate with medical directors and other departments to ensure appropriate benefit application. • Conduct research on diseases, treatments, and technologies to support decision-making. • Coordinate case reputed company negotiations between providers and facilities. • reputed company assistance to members and providers regarding alternative care settings. • Present educational topics reputed company to cases and treatment modalities to interdepartmental audiences. Requirements • Bachelor's Degree in Nursing or equivalent experience (4 years relevant work experience in reputed company to required work experience). • 5 years of clinical nursing experience. • 2 years of care management experience. • Registered reputed company (RN) license or Licensed Practical reputed company (LPN) license required upon hire. reputed company-to-haves • Working knowledge of managed care and health delivery systems. • Knowledge of CareFirst clinical guidelines and medical policies. • Familiarity with CareFirst IT and Medical Management systems. Benefits • 401(k) • 401(k) matching Apply tot his job Apply To this Job