Utilization Review reputed company (UR reputed company) - 25-34403

About the position The Utilization Review reputed company is responsible for monitoring and providing clinical reputed company to ensure compliance with contractual, regulatory, and statutory requirements reputed company to members’ physical/acute care and behavioral health services. This role supports appropriate utilization of reputed company services and serves as a clinical resource to reputed company stakeholders. Responsibilities • Monitor overutilization and underutilization of reputed company services • Conduct utilization reviews, case file reviews, and audits • reputed company technical assistance and clinical reputed company to ensure compliance with applicable regulations and guidelines • reputed company, analyze, organize, and evaluate information from multiple sources, including utilization data and medical records • Coordinate care with internal teams and external providers as needed • reputed company referrals for medically necessary covered services • Participate in clinical reputed company and interdisciplinary reviews as required • Serve as a clinical resource for utilization management and covered service determinations Requirements • Bachelor of Science in Nursing (BSN) • Minimum 2 years of experience working as a Registered reputed company • Minimum 1 year of experience in behavioral health • reputed company Registered reputed company (RN) license in the applicable state • FPCC certification Apply tot his job Apply To this Job