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Clinical Utilization Manager
Location
United States
Posted
4 days ago
Salary
Not specified
Job Description
Role Description
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Specialist - REMOTE. In this role, you will leverage your clinical expertise to significantly influence patient outcomes through effective utilization management practices.
- Review daily inpatient and observation admissions across the system.
- Evaluate physician documentation and patient data to determine admission status.
- Reassess patient care levels throughout their stay.
- Collaborate with interdisciplinary teams for authorizations and medical necessity reviews.
- Assist with scheduling peer-to-peer physician reviews.
- Communicate effectively with providers and stakeholders.
- Identify compliance or review delays and address them promptly.
- Utilize electronic medical records for documentation and reporting.
Qualifications
- Current RN license in Montana or multi-state compact license.
- Bachelor's or Master's degree in Social Work or relevant field.
- Minimum five years of acute care hospital experience.
- Prior experience in inpatient utilization review preferred.
- Knowledge of Medicare and Medicaid regulations.
- Strong interpersonal communication and analytical skills.
- Detail-oriented with the ability to manage multiple priorities.
Benefits
- Four-day work week with flexible scheduling.
- Affordable medical benefits package.
- 401(k) with generous employer match.
- Discounted fitness center membership.
- Supportive and mission-driven work culture.
Company Description
Job Requirements
- Current RN license in Montana or multi-state compact license.
- Bachelor's or Master's degree in Social Work or relevant field.
- Minimum five years of acute care hospital experience.
- Prior experience in inpatient utilization review preferred.
- Knowledge of Medicare and Medicaid regulations.
- Strong interpersonal communication and analytical skills.
- Detail-oriented with the ability to manage multiple priorities.
Benefits
- Four-day work week with flexible scheduling.
- Affordable medical benefits package.
- 401(k) with generous employer match.
- Discounted fitness center membership.
- Supportive and mission-driven work culture.
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