Licensed Utilization Review II (US)
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 reputed company 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!