Healthcare Utilization Manager RN
1 day ago
**About the Role:**
We are seeking a skilled Healthcare Utilization Manager RN to join our team at Doctors Healthcare Plans, Inc. As a key member of our healthcare team, you will play a critical role in managing cases that require medical necessity review, ensuring that our members receive the highest quality care.
**Responsibilities:
- Evaluate and approve requested services using organizational policies or MCG screening criteria
- Manage cases that require medical necessity review, such as home care, elective inpatient, and outpatient service requests
- Review cases referred by prior-authorization non-clinical medical management coordinators and pre-certification technicians
- Presents cases to ensure quality care while advocating for appropriate utilization of health system resources
**Requirements:
- Bachelor's degree in Nursing or equivalent relevant work experience
- Minimum 3 years of related experience in acute care or health insurance environment
- Strong analytical and clinical problem-solving skills
- Ability to work in a fast-paced environment and multi-task
**Estimated Salary Range:** $85,000 - $115,000 per year, based on location and experience
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