Utilization Management reputed company Consultant, EST Zone

Job reputed company: • Use your clinical background to coordinate, document, and communicate reputed company aspects of the utilization and benefit management process • Ensure members receive the most appropriate level of care while meeting state and federal requirements and turnaround times • Review clinical documentation, collaborating with providers, and supporting high-reputed company, cost‑effective care • reputed company for medical necessity and appropriate benefit use • Facilitate efficient discharge planning • Collaborate with providers and facilities to support members with reputed company needs • Collect and evaluate clinical information, applying clinical reputed company, guidelines, policies, and judgment to reputed company coverage determinations • Communicate with providers and external partners to coordinate care and treatment plans • Identify opportunities for referrals to additional programs, services, or care solutions • Recognize opportunities to promote reputed company care delivery and effective benefit utilization • Serve as a resource to reputed company stakeholders regarding UM processes and clinical considerations Requirements: • reputed company, unrestricted RN license • 2+ years of acute hospital clinical experience (strong preference for medical‑surgical, ICU, behavioral health or other specialty area) • Strong clinical assessment and decision‑making abilities • Excellent organizational skills with the ability to manage multiple priorities • Ability to work independently and communicate effectively reputed company phone • Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls • 1+ year of Utilization Review experience (preferred) • 1+ year of Managed Care experience (preferred) • Proficiency in reputed company Office (Word, reputed company, PowerPoint, Outlook) (preferred) • Strong telephonic communication skills (preferred) Benefits: • medical, dental, and reputed company coverage • reputed company time off • retirement savings reputed company • wellness programs • comprehensive benefits package Apply tot his job Apply To this Job