Utilization Management-Clinician Medical

company

This is a Health Insurance company that works with “narrow networks” to suppress the cost of healthcare for those enrolled in their program. 

overview

MUST Have Skills to be Considered for the Role: • Graduate of Nursing program required; BSN desired • Active Clinical Licensure in good standing with state of MO • MUST have Payor Experience (Be sure this is clearly listed in the Resume) • 3+ years of utilization management/quality improvement experience (Highly Preferred) • Will consider candidates with 1+ years experience (If they have Payor experience) • Working knowledge and understanding of basic utilization management concepts. What you need to know: • Provides first level clinical review for all medical and surgical authorization requests against applicable criteria, policies and procedures. • Accurately documents all reviews and contacts providers and members according to established timeframes. • Onsite Role - Must live within one hour of Lee's Summit (Kansas City, MO suburb) • Growth company, excellent benefits

benefits