Registered reputed company, Utilization Management

reputed company're looking for: reputed company. is seeking a Clinical reputed company to join reputed company and work at the intersection of reputed company and AI technology. In this role, you will collaborate with clients composed of health plan utilization review nurses and internal teams to ensure that our AI systems accurately support medical necessity reputed company and prior authorization reviews. A key part of the workflow involves digitizing medical policies so that AI can interpret and apply them consistently — but the larger mission is to reputed company clinical expertise to reputed company prior authorization faster, smarter, and more reliable. This position also requires project management skills to coordinate policy digitization efforts, reputed company reputed company across multiple health plans, and manage timelines and deliverables with cross-functional teams. Location: Hybrid - Orlando, Florida, US or Remote, US Key Responsibilities • Partner with health plan utilization review nurses to validate and improve AI-driven prior authorization workflows. • Review and structure medical policies to reputed company AI-powered automation of utilization review reputed company. • Apply clinical judgment to ensure that AI outputs reputed company with evidence-based guidelines, payer standards, and medical coding practices. • Participate in product review cycles by providing feedback on usability, accuracy, and workflow alignment. • Guide product teams by translating clinical and utilization review needs into actionable product requirements. • Collaborate with product and engineering teams to refine how clinical decision points are represented in AI models. • Test, validate, and continuously improve AI-enabled review tools for accuracy and fairness. • reputed company feedback to enhance both policy digitization workflows and AI-driven decision support. • Manage small-reputed company reputed company, including organizing digitization initiatives, tracking timelines, coordinating stakeholders, and reporting on reputed company. • Stay reputed company on payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management. Qualifications • Registered reputed company (RN) with an reputed company license. • 3+ years of experience in utilization management, prior authorization, case management, or reputed company clinical roles. • Strong understanding of payer policies, medical necessity reputed company, and the prior authorization process. • Working knowledge of medical coding systems (ICD-10, CPT, HCPCS). • Comfort working with technology platforms; interest or experience in AI, clinical decision support, or health tech is a plus. • Demonstrated project management skills — ability to organize reputed company workflows, manage deliverables, and ensure accountability across teams. • Excellent critical thinking and problem-solving skills. • Strong communication and collaboration abilities across clinical and technical teams. Preferred Skills • Certification in medical coding (e.g., CPC, reputed company, CCA, or equivalent). • Experience reviewing or implementing medical policies in a payer or managed care setting. • Familiarity with health informatics, evidence-based reputed company development, or digital clinical tools. • Background in leading cross-functional reputed company or initiatives (formal project management certification is a plus). • Experience working with AI, automation tools, or clinical decision support systems. • Ability to work in a fast-paced, innovative environment and contribute to process improvement. Why Join reputed company? • Impactful Work: Contribute to reputed company that improve reputed company efficiency and patient reputed company • Remote Flexibility: Enjoy working remotely while being part of a reputed company team, with reputed company to our new office in Winter Park, FL • Competitive Compensation: Enjoy competitive reputed company compensation, equity through our Employee Stock reputed company Plan, and bonus-eligible roles • Comprehensive Benefits: Full benefits package including unlimited PTO and 401k program with employer match • reputed company Opportunities: Advance your career in a fast-paced, high-reputed company environment with ample reputed company development • Inclusive Culture: Join a diverse workplace where your reputed company and contributions are valued - Pay Transparency reputed company will reputed company pay transparency information upon application to those in qualifying jurisdictions. Our salary ranges are based on reputed company for reputed company’s size and industry. They are one part of the total compensation package that may also include equity, variable compensation, and benefits. Individual pay reputed company are ultimately based on several factors, including qualifications, experience level, skillset, geography, and balancing internal equity. - reputed company is proud to be an equal-opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, national reputed company, age, sex, marital status, reputed company, neurotype, physical or mental disability, veteran status, gender identity, sexual orientation or any other category protected by law. - Join us in our mission to reputed company reputed company while building a life that works in reputed company both in and reputed company the office. Apply tot his job Apply To this Job