Flexible Work, Better Balance
Position Summary:
The Insurance Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse, physicians, staff and other health care professionals. Interacts with internal and external providers to review and monitor members’ utilization of health care services with the goal of maintaining high-quality cost-effective care. Works collaboratively with staff to obtain information from clinical reviews and medical records in order to provide the appropriate communication for authorization of medical services and procedures. Collaborates on system-wide quality improvement/performance improvement.
Initiates and ensures authorizations for all admissions • Extracts meaningful data from the medical record of identi...