Utilization Management Clinician
2 weeks ago
The Utilization Management Clinician plays a critical role in ensuring that our members receive high-quality, cost-effective care. As a key member of our care coordination team, you will be responsible for conducting thorough reviews of hospital notifications and prior authorization requests to ensure that they meet our clinical guidelines and health plan policies.
You will work closely with facilities to perform discharge planning and provide coordination support to members transitioning between care settings or returning home from a hospitalization. Your expertise will help identify member needs and ensure that necessary services are available during the transition period.
As a Utilization Management Clinician, you will collaborate with providers, office staff, and care coordination team members to assure coordination of care in a timely manner according to contractual and regulatory timeframes. You will also identify potentially unnecessary services and/or delivery settings and recommend appropriate alternatives.
Key Responsibilities:
- Conduct thorough reviews of hospital notifications and prior authorization requests
- Collaborate with facilities to perform discharge planning
- Provide coordination support to members transitioning between care settings
- Identify member needs and ensure necessary services are available
- Collaborate with providers and care coordination team members to assure coordination of care
- Identify potentially unnecessary services and/or delivery settings and recommend alternatives
Requirements:
- Bachelor's degree in a relevant field or equivalent combination of education and experience
- Current, unrestricted license as an RN or LPN
- At least two years of clinical experience in a physical health or behavioral health setting
- Previous experience in utilization management and managed care preferred
What We Offer:
- Competitive salary and benefits package
- Opportunities for professional growth and development
- Collaborative and dynamic work environment
- Recognition and rewards for outstanding performance
CHPW is an Equal Opportunity Employer:
We are committed to creating a diverse and inclusive workforce that reflects the communities we serve. We welcome applications from qualified candidates of all backgrounds and perspectives.
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