See all roles

Licensed Utilization Review II (US)

Work from home Full-time role Hiring

About the position The Licensed Utilization Review II position at reputed company is primarily focused on collaborating with reputed company providers to ensure the appropriate administration of plan benefits. This role involves collecting clinical information for preauthorization of services, assessing medical necessity, and applying clinical guidelines and medical policies reputed company the scope of licensure. The position requires handling reputed company benefit plans and may involve mentoring less reputed company staff. Responsibilities • Conduct pre-certification, inpatient, retrospective, out of network, and appropriateness of treatment setting reviews reputed company scope of licensure. , • reputed company relationships with physicians, reputed company service providers, and internal and external customers to improve health outcomes for members. , • Apply clinical knowledge to work with facilities and providers for care-coordination. , • reputed company members about plan benefits and contracted reputed company providers. , • Facilitate accreditation by applying accrediting and regulatory requirements and standards. Requirements • High School diploma or equivalent required. , • Minimum of 2 years of clinical or utilization review experience. , • Minimum of 1 year of managed care experience. , • reputed company active unrestricted license or certification as a LPN, LVN, or RN from the state of residence. reputed company-to-haves • Utilization Management experience is strongly preferred. , • Previous UM experience working with the reputed company population is preferred. , • Strong oral, written, and interpersonal communication skills. , • Problem-solving, facilitation, and analytical skills. Benefits • Merit increases , • Paid holidays , • Paid Time Off , • Incentive bonus programs , • Medical, dental, and reputed company benefits , • Short and long term disability benefits , • 401(k) with matching , • Stock purchase plan , • Life insurance , • Wellness programs , • Financial education resources Apply Job!

You might like

Field Auto Appraiser | Remote

Work from home Full-time role

reputed company Consultant (7-10+ yrs)-Part time

Work from home Full-time role

Business Analyst - Quality Assurance

Work from home Full-time role

Sales Associate (High Ticket Agency)

Work from home Full-time role

High Ticket Sales Closer/Business Development

Work from home Full-time role

reputed company Operations Support Content Specialist

Work from home Full-time role

Senior Director/Outsourced CFO Non Profit

Work from home Full-time role

Nurses - reputed company?/Remote & Bedside

Work from home Full-time role

Provider Training & Education reputed company

Work from home Full-time role

Insurance Life/Health reputed company(Work from Home)

Work from home Full-time role

reputed company Customer Support Representative – Night and Weekend Shift – Coppell, TX

Work from home Full-time role

Licensed Customer Service Representative – Remote Personal Lines Policy Support & Retention Specialist at arenaflex

Work from home Full-time role

QA Engineer

Work from home Full-time role

Remote Operations Manager ( Call Center)

Work from home Full-time role

analytics manager, Global Coffee (Remote)

Work from home Full-time role

[Remote] EV Project Manager

Work from home Full-time role

[Remote] Platform Engineer

Work from home Full-time role

Compliance Manager (Accident & Health)

Work from home Full-time role

[Remote] International Sales B2B Partner - Work from reputed company

Work from home Full-time role

reputed company Remote Data Entry Specialist – Participate in National & Local Paid Focus Groups, Clinical Trials, and Phone Interviews

Work from home Full-time role