**Job Description:**

This position is a hybrid role that combines the roles and expertise of Utilization Review and Care management. This role is essential in ensuring that members receive high-quality, cost-effective care. Overall, utilization management is an essential process that not only ensures the medical necessity of care but also assists in monitoring and controlling healthcare costs while prioritizing member safety. These processes involve detailed assessments, evidence-based guidelines, and coordination among various healthcare professionals to achieve optimal outcomes for members. The ideal candidate will possess a strong understanding of utilization management principles, as well as a solid foundation in healthcare operations and regulatory compliance.
Candidates will apply expertise to review medical records and treatment plans for individuals with specific conditions or diagnosis including medical and behavioral health conditions to ensure that services are m...