About the role
Nursing Graduates for Utilization Management
Specialist/Prior Authorization Specialist
Job Title: Utilization
Management Specialist/Prior Authorization Specialist
Job Description:
We are looking for a motivated and
detail-oriented Utilization Management Specialist to join our team. As a
fresher In this role, you will help review medical information to ensure that
healthcare services are necessary and follow best practices. You will support
the approval of healthcare services to ensure they are cost-effective and meet
patient needs.
Preferred Skills
üFamiliarity
with MCG/Inter Qual Guidelines is a plus.
üKeep
up-to-date with regulations and maintain organized records of all activities.
üExperience
with Medicaid, Medicare, and Managed Care is helpful.
üStrong
knowledge of anatomy, physiology, and medical terminology.
üProficient
in MS Office applications.
üExcellent
communication skills and ability to work both independently and in a team.
üStrong
analytical and problem-solving skills.
Requirements
Key Functions:
üReview
outpatient procedures, inpatient admissions, home health, and behavioral health
services to check if they are necessary.
üWork
with providers and medical directors to get prior authorization and plan for
case reviews when needed.
üCollaborate
with clinical staff to ensure appropriate care and resource use.
üParticipate
in quality improvement projects and help develop clinical guidelines.
üMonitor
and report on utilization trends to management.
Qualifications :
Candidates
with a Bachelor's Degree in Nursing are eligible to apply
Freshers
also can apply.
Candidates
already having work experience in a Hospital Field is an added advantage.