Utilization Management Professional,

Job description

Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services. Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information. Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria. · Caseload: 25-30 reviews per day. This position is 98% telephonic. The candidate will work an 8 hour shift that could start between the hours of 8am – 10:30am. Requirements/Certifications: THIS IS A TEMP-TO-PERM POSITION. Caseload: 25-30 reviews per day. The majority of the caseload is via fax. The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp. A strong candidate would be familiar with MCG and Interqual. License and Educational requirement: LPN - Licensed Practical Nurse. An Associate’s Degree is required for the LPN and the RN – Registered Nurse – A Bachelor’s Degree is required for the RN All your information will be kept confidential according to EEO guidelines. Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow. We’ve stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity. Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients’ success.