UM - Fresher

Nursing Graduates for Utilization Management Specialist/Prior Authorization Specialist

Job Title:

Preferred Skills

Familiarity with MCG/Inter Qual Guidelines is a plus.

Keep up-to-date with regulations and maintain organized records of all activities.

Experience with Medicaid, Medicare, and Managed Care is helpful.

Strong knowledge of anatomy, physiology, and medical terminology.

Proficient in MS Office applications.

Excellent communication skills and ability to work both independently and in a team.

Strong analytical and problem-solving skills.

Key Functions:

Review outpatient procedures, inpatient admissions, home health, and behavioral health services to check if they are necessary.

Work with providers and medical directors to get prior authorization and plan for case reviews when needed.

Collaborate with clinical staff to ensure appropriate care and resource use.

Participate in quality improvement projects and help develop clinical guidelines.

Monitor and report on utilization trends to management.

Qualifications :

Bachelor's Degree in Nursing

Freshers also can apply.

work experience in a Hospital Field