Utilization Management Professional,

• Under general supervision by management, 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.

· Caseload: 25-30 reviews per day. This position is 98% telephonic.

The candidate will work an 8 hour shift that could start between the hours of 8am – 10:30am.

Requirements/Certifications:

• THIS IS A TEMP-TO-PERM POSITION.

• Caseload: 25-30 reviews per day. The majority of the caseload is via fax.

• The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp.

• A strong candidate would be familiar with MCG and Interqual.

• License and Educational requirement: LPN - Licensed Practical Nurse.

• An Associate’s Degree is required for the LPN and the RN – Registered Nurse – A Bachelor’s Degree is required for the RN

All your information will be kept confidential according to EEO guidelines.