UM Clinical Reviewer
About the role
The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. This role involves assessing and processing all authorization requests to determine medical necessity.
Responsibilities
- Identify and manage members who require additional care or support in their home
- Assess and process all authorization requests to determine medical necessity
- Maintain all care services, member education, and preventative interventions
Qualifications
- Active RN license
- Entry level RN welcome
- Excellent written and verbal communication skills
- Able to meet tight deadlines
- Strong problem-solving skills
- Proficient in the use of Microsoft Office Suite tools
Who We Are
We are a fast-growing Managed Long-Term Care company dedicated to helping eligible individuals remain in the community rather than being institutionalized. Our approach includes ongoing assessment of members' care/social needs, development of a "living care plan," and coordination with community providers and members/families/care decision makers. We are committed to creating opportunities for our employees and are an equal opportunity employer.