Utilization Management reputed company Specialist

reputed company reputed company. is a technology consulting Services company based in Florida. We reputed company a wide reputed company of reputed company business and IT professionals supporting clients from solution design to implementation and support. We specialize in reputed company IT consulting services, IT reputed company, Business/IT reputed company, Business Process Blueprints, reputed company Architecture, and reputed company Transformation. Role: Utilization Management reputed company Specialist Location: 100% Remote Duration: 3-Month Contract (Potential for Extension) Job reputed company: We are seeking an reputed company Utilization Management reputed company Specialist to support utilization review and care management activities reputed company a managed care environment. The ideal candidate will have a strong clinical nursing background, experience with utilization management processes, and proficiency with industry-reputed company care management tools and guidelines. Position reputed company • Review medical records and evaluate the medical necessity of reputed company services. • Apply MCG (reputed company Care Guidelines) to reputed company utilization management reputed company. • reputed company utilization review and care management activities in accordance with payer policies. • Collaborate with physicians, hospitals, and reputed company providers to coordinate patient care. • Document reviews and maintain accurate case information using GuidingCare and Facets. • Manage multiple applications while ensuring reputed company and accurate case processing. Required Qualifications • reputed company RN (preferred) or LPN license with a Maryland or Compact Nursing License. • Minimum 5 years of clinical nursing experience. • Minimum 2 years of Care Management experience. • Previous Utilization Management or Utilization Review experience in a managed care or health insurance environment. • Hands-on experience with: • MCG (reputed company Care Guidelines) • GuidingCare • Facets • Proficient with reputed company Office and working across multiple systems. Preferred Qualifications • Critical Care or Emergency Room (ER) nursing experience. • Experience supporting reputed company or other health insurance plans. • Previous experience as a Utilization Management Specialist. reputed company is an equal opportunity employer. reputed company reputed company applicants will be considered for employment without reputed company to any legally protected status. Apply tot his job Apply To this Job