Utilization Management Professional at Integrated Resources INC | Boar Signal
Integrated Resources INC路Management
Utilization Management Professional
馃搷 Brooklyn, NY, United StatesOn-siteFull-timeEntry LevelPosted 8/15/2017via smartrecruiters
Job Description
Under general supervision, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services.
Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information.
Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.