Utilization Management Specialist

As a Utilization Management Specialist/Prior Authorization Specialist, you will be responsible for reviewing medical information to ensure the necessity of healthcare services and adherence to best practices. Your role will involve supporting the approval of cost-effective healthcare services that meet patient needs. Key Responsibilities: - Review outpatient procedures, inpatient admissions, home health, and behavioral health services to determine their necessity. - Collaborate with providers and medical directors to obtain prior authorization and plan for case reviews as required. - Work with clinical staff to ensure appropriate care and resource utilization. - Participate in quality improvement projects and assist in developing clinical guidelines. - Monitor and report on utilization trends to management. Qualifications Required: - Bachelor's Degree in Nursing is a mandatory qualification for this role. - Freshers are welcome to apply. - Prior work experience in the hospital field is considered an added advantage. If you are a detail-oriented individual with a passion for ensuring the efficiency and appropriateness of healthcare services, and possess strong communication, analytical, and problem-solving skills, we encourage you to apply. Please send your updated resume to hr@shai.health. For further inquiries, you can contact us at 78457 70407.,