Utilization Management Specialist

1 week ago


Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time
About the Role

We are seeking a skilled Utilization Management Reviewer-Long Term Care to join our team at Presbyterian Healthcare Services. As a critical member of our team, you will play a key role in ensuring that our members receive the best possible care.

Key Responsibilities
  • Conduct thorough reviews of medical documentation to determine the level of care required for our members, in accordance with state regulations and established criteria.
  • Perform utilization review activities to ensure that services rendered to members meet Long Term Care Supports and Services (LTSS) criteria and are delivered in the appropriate setting.
  • Utilize LTSS skills and established criteria to review, coordinate, document, and approve all aspects of the utilization/benefit management program.
Requirements
  • Active Nursing license in New Mexico or compact license (RN or LPN) with a minimum of one year of relevant experience.
  • Medical Social Worker with a minimum of one year of relevant experience.
  • Physical, Occupational, or Rehab Therapists with a minimum of one year of relevant experience.
  • Prefer 1 year of experience in a Managed Care Organization (MCO), health plan insurance environment, with expertise performing utilization management or experience working in long term care services.
Benefits
  • Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, group term life insurance, and other optional voluntary benefits.
  • Employee Wellness rewards program designed to provide opportunities to enhance your health and activate your well-being.
About Presbyterian

Presbyterian Healthcare Services exists to improve the health of patients, members, and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan, and a growing multi-specialty medical group.

We value our employees' differences and find strength in the diversity of our team and community. We are committed to improving the health of our communities and taking active steps to improve the health of New Mexicans.

We are an equal opportunity employer and welcome applications from diverse candidates.

Presbyterian is a drug-free and tobacco-free employer with smoke-free campuses.

The maximum offer for this position is up to $44.49/Hr.



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