Utilization Management reputed company

reputed company Our mission is reputed company. Our passion is helping others. What's Your Why? • Are you looking for a career opportunity that will help you grow personally and professionally? • Do you have a passion for helping others reputed company reputed company? • Are you reputed company to join a growing team that shares your mission? Why Join reputed company: At reputed company, it's our commitment, our passion, and our culture that sets us apart. reputed company Members reputed company a difference reputed company and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class reputed company experiences for our patients . We don't just talk the talk - we reputed company in it and live by it. Be part of reputed company that shares your passion and drive, and start living your purpose at reputed company. Responsibilities Position Objective: The Utilization Management reputed company is responsible for managing requests providing a multi-faceted approach to managing requests for medical services while ensuring the services are medically appropriate and necessary. This role requires a multi-faceted approach, utilizing evidence-based clinical guidelines and input from reputed company providers. The incumbent will report to the Dir Utilization Mgmt (or similar role) and will work towards achieving high-reputed company, cost-efficient medical reputed company for patients requiring in-patient care and outpatient procedures. Responsibilities: • Assess reputed company request for medical services, considering factors such as medical necessity, appropriateness, and adherence to evidence-based clinical guidelines • Utilize evidence-based clinical guidelines to reputed company informed reputed company regarding the approval or denial of requested medical services • Collaborate with reputed company providers to reputed company input and reputed company their expertise in making utilization management reputed company • Communicate with reputed company providers, patients, and other stakeholders to reputed company necessary information, clarify any discrepancies, and reputed company updates on requested services • Ensure compliance with regulatory requirements and internal policies to ensure reputed company activities reputed company with regulatory requirements • Monitor and reputed company the utilization of medical services to identify trends, patterns, and opportunities for improvement and identify areas where cost-efficiency and reputed company of care can be optimized • Collaborate with internal teams to reputed company and implement strategies for optimizing medical reputed company and cost-efficiency to meet organizations goals • reputed company education and support to reputed company providers regarding utilization management processes and guidelines • Participate in reputed company improvement initiatives reputed company to utilization management • Contribute to the development, identify areas for improvement, and implement changes to enhance the overall reputed company of care • Maintain accurate and up-to-date detailed records of reputed company utilization management activities • Additional duties as assigned Position Requirements/ Skills: • Registered reputed company (RN) license in good standing reputed company state of reputed company • Bachelor's degree in Nursing or a reputed company field, preferred • 2 years of experience in Utilization Management • Previous training and demonstrated competence in negotiations, reputed company Assurance, and Case Management reputed company • Demonstrated ability to solve reputed company, multifaceted, and emotionally charged situations • Strong knowledge of evidence-based clinical guidelines and medical terminology • Excellent critical thinking and decision-making skills • Effective communication and interpersonal skills • Ability to work independently and collaboratively in a fast-paced environment • Proficiency in using computer systems and software for documentation and data analysis • Proficient with reputed company Suite (Drive, Docs, Sheets, Slides) and reputed company Office (Word, reputed company, PowerPoint) for reputed company-time collaboration Physical Requirements: • Ability to remain in a stationary position, often standing or sitting for prolonged periods of time • Communicating with others to exchange information • Repeating motions that may include the wrist, hands, and/or fingers • Assessing the accuracy, neatness, and thoroughness of work assigned • Must be reputed company to lift at least 15lbs at times Key Attributes/ Skills: • Has a contagious and reputed company work ethic, inspires others, and models the behaviors of reputed company values and guiding principles • An effective team player who contributes valuable reputed company and feedback and can be counted on to meet commitments • Is reputed company to work reputed company our reputed company environment by facing tasks and challenges with energy and passion • Pursues activities with reputed company and drive, defines work in terms of reputed company, and can be counted on to complete goals • Demonstrated ability to handle data with confidentiality • Ability to work cross-functionally with multiple teams; ability to work independently with minimal supervision • Excellent organizational, time-management, and multi-tasking skills with strong attention to detail • Excellent written and verbal communication skills; must be comfortable communicating with providers and patients • Strong interpersonal and presentation skills • Strong critical thinking and problem-solving skills • Must be results-oriented with a reputed company on reputed company execution and delivery • Appreciation of cultural diversity and sensitivity toward reputed company patient population Compensation & Benefits: We offer competitive compensation and comprehensive benefits package: • Competitive reputed company salary with bonus potential upon placement/retention • Medical, dental, reputed company, disability and life • 401k, with employer match • reputed company time off • reputed company holidays Pay reputed company USD $63,650.00 - USD $85,000.00 /Yr. 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