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Nursing Graduates for Utilization Management\nSpecialist/Prior Authorization Specialist<\/span><\/span><\/span><\/span><\/b>
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Job Title:<\/span><\/span><\/span><\/span><\/b> Utilization\nManagement Specialist/Prior Authorization Specialist<\/span><\/span><\/span><\/span>
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Job Description:<\/span><\/span><\/span><\/span><\/b>
We are looking for a motivated and\ndetail\-oriented Utilization Management Specialist to join our team. As a\nfresher In this role, you will help review medical information to ensure that\nhealthcare services are necessary and follow best practices. You will support\nthe approval of healthcare services to ensure they are cost\-effective and meet\npatient needs.<\/span><\/span><\/span><\/span>
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Preferred Skills<\/span><\/span><\/span><\/span><\/b>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Familiarity\nwith MCG/Inter Qual Guidelines is a plus.<\/span><\/span><\/span><\/span>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Keep\nup\-to\-date with regulations and maintain organized records of all activities.<\/span><\/span><\/span><\/span>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Experience\nwith Medicaid, Medicare, and Managed Care is helpful.<\/span><\/span><\/span><\/span>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Strong\nknowledge of anatomy, physiology, and medical terminology.<\/span><\/span><\/span><\/span>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Proficient\nin MS Office applications.<\/span><\/span><\/span><\/span>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Excellent\ncommunication skills and ability to work both independently and in a team.<\/span><\/span><\/span><\/span>
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ü <\/span><\/span><\/span><\/span><\/span><\/span>Strong\nanalytical and problem\-solving skills.<\/span><\/span><\/span><\/span>
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\u200b<\/span><\/span><\/span><\/span>
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Requirements<\/h3>

Key Functions:<\/span><\/span><\/span><\/b>
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ü<\/span> <\/span><\/span><\/span><\/span><\/span><\/span><\/span>Review\noutpatient procedures, inpatient admissions, home health, and behavioral health\nservices to check if they are necessary.<\/span><\/span><\/span><\/span><\/span>
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ü<\/span> <\/span><\/span><\/span><\/span><\/span><\/span><\/span>Work\nwith providers and medical directors to get prior authorization and plan for\ncase reviews when needed.<\/span><\/span><\/span><\/span><\/span>
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ü<\/span> <\/span><\/span><\/span><\/span><\/span><\/span><\/span>Collaborate\nwith clinical staff to ensure appropriate care and resource use.<\/span><\/span><\/span><\/span><\/span>
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ü<\/span> <\/span><\/span><\/span><\/span><\/span><\/span><\/span>Participate\nin quality improvement projects and help develop clinical guidelines.<\/span><\/span><\/span><\/span><\/span>
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ü<\/span> <\/span><\/span><\/span><\/span><\/span><\/span><\/span>Monitor\nand report on utilization trends to management.<\/span><\/span><\/span><\/span><\/span>
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Qualifications :<\/span><\/span><\/span><\/span><\/b>
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Candidates\nwith a <\/span><\/span><\/span><\/span>Bachelor's Degree in Nursing<\/span><\/span><\/span><\/span><\/b> are eligible to apply<\/span><\/span><\/span><\/span>
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Freshers\nalso can apply.<\/span><\/span><\/span><\/span>
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Candidates\nalready having <\/span><\/span><\/span><\/span>work experience in a Hospital Field<\/span><\/span><\/span><\/span><\/b> is an added advantage.<\/span><\/span><\/span><\/span>
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