Clinical Utilization Specialist
4 days ago
Job Title: Clinical Utilization Specialist
About Emonics LLC:
Emonics LLC is a reputable healthcare organization that offers outpatient services. Our team consists of experienced professionals dedicated to delivering high-quality care.
Salary:$85,000 - $110,000 per year (based on experience)
About the Job:
We are seeking a skilled Registered Nurse for our utilization review team. The successful candidate will have 3 years of clinical experience in a hospital or urgent care setting and proficiency in ICD10, CPT, and HCPC coding systems. Additionally, they should be familiar with HMO, PPO, and POS plans. Preferred candidates will have managed care experience and knowledge of medical management processes and NCQA regulations.
Responsibilities:
- Conduct thorough utilization reviews to ensure patients receive necessary care
- Collaborate with healthcare providers to optimize patient outcomes
- Stay up-to-date with industry developments and best practices
Requirements:
- RN license in California
- 3 years of clinical experience in a hospital or urgent care setting
- Knowledge of ICD10, CPT, and HCPC coding systems
- Familiarity with HMO, PPO, and POS plans
Benefits:
- Competitive salary range: $85,000 - $110,000 per year
- Opportunities for professional growth and development
- Collaborative and dynamic work environment
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