Clinical Utilization Specialist
2 days ago
Job Description:
This role involves reviewing medical necessity and appropriateness of treatment plans in the insurance or managed care industry using medically accepted criteria.
The ideal candidate will have 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company, with knowledge of medical terminology and procedures. Verbal and written communication skills are essential for this position.
Responsibilities:
- Perform initial, concurrent review activities to determine efficiency, effectiveness, and quality of medical/surgical services.
- Collect and verify clinical and non-clinical data.
- Determine benefit levels in accordance with contract guidelines.
- Provide information regarding utilization management requirements and operational procedures to members, providers, and facilities.
Requirements:
- Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
- Knowledge of medical terminology and procedures.
- Verbal and written communication skills.
- Utilization Management experience is preferred.
Location: Remote in Texas, with locations in the Austin area (Travis/Williamson Counties) and Richardson area (Dallas/Collin Counties).
Compensation: This is a 6-month assignment with an hourly rate of $38-$40, working 40 hours per week, 8 hours per day.
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