Medical Management Professional

5 days ago


Toulouges, Occitanie, United States WellSky Full time
Job Overview

We are seeking a skilled Medical Management Professional to join our team at WellSky. This role is responsible for performing prospective and retrospective reviews of post-acute care services, ensuring that our population receives medically necessary services in the appropriate setting.

About the Role

The Utilization Review Specialist will work closely with physicians, healthcare service providers, and internal/external customers to improve health outcomes for enrollees. Key responsibilities include:

  • Performing initial prior authorization review of post-acute care services applying guideline criteria for approval
  • Authorizing post-acute care services in compliance with contractual agreements, health plan guidelines, and medical necessity criteria
  • Successfully completing Interrater Reliability Testing to ensure consistency of review and application of criteria

This is an exciting opportunity for a motivated individual who wants to make a difference in the lives of others.

What We Offer

As a valued member of our team, you can expect:

  • $76,000 - $90,000 per year
  • Excellent medical, dental, and vision benefits
  • Mental health benefits through TelaDoc
  • Generous paid time off, plus 13 paid holidays
  • Paid parental leave
  • 100% vested 401(K) retirement plans
Requirements

To be considered for this role, you must have:

  • An active RN license
  • 5+ years of clinical nursing experience

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