Utilization Management Analyst

4 days ago


Hamtramck, Michigan, United States Strategic Staffing Solutions Full time

About Strategic Staffing Solutions

At S3, we strive to build trusting relationships and deliver solutions that positively impact our customers, consultants, and communities. Our four pillars are to set the bar high, create jobs, offer people opportunities to succeed, and improve the communities where we live and work.

Job Description

This role involves performing strategic reviews of medical services to ensure they meet specific criteria. You will work closely with healthcare professionals to identify areas for improvement and implement changes to optimize patient outcomes.

Key Responsibilities

  • Conduct thorough reviews of medical services, including inpatient, outpatient, and ancillary services
  • Develop and maintain relationships with healthcare providers, facilities, and members
  • Provide expert advice on medical necessity, length of stay, and intensity of service
  • Collaborate with internal stakeholders to develop and implement quality improvement initiatives

Requirements

  • Bachelor's degree in nursing, allied health, business, or related field
  • Current unrestricted Michigan Registered Nurse license required
  • One (1) year health insurance plan experience or managed care environment preferred

Estimated Salary Range

$85,000 - $110,000 per year, depending on experience.



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