Clinical Utilization Specialist

2 days ago


San Antonio, Texas, United States Bracane Company Full time

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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