Offer summary
Qualifications:
2 to 5 years of clinical experience, Experience in Utilization Management or Review, Handling Appeals and Grievances experience, Valid New York State nursing license.
Key responsabilities:
- Manage hospital admissions, discharge planning, and outpatient service reviews
- Coordinate healthcare services focusing on cost-effectiveness
- Collaborate with providers to gather clinical information and approve care
- Identify utilization patterns through reports and health assessments
- Ensure compliance with regulatory requirements and assist with member concerns