Utilization Management Specialist - Fresher

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
  

Requirements

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.
  

Qualifications :

• Candidates with a Bachelor's Degree in Nursing are eligible to apply
• Freshers can also apply.
• Candidates already having work experience in the Hospital Field is added advantage.
  

Benefits

Perks and Benefits

• Five Days of working
• Saturday and Sunday fixed Week off
• Double Wages (If working on Saturday/Sunday)
• Both 2-way Cab facility Available for only Night Shift