Utilization Management Clinical Consultant

Job not on LinkedIn

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Lifelancer

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2020

💼 Consulting

🏥 Healthcare

📦 Logistics

💰 Pre Seed Round on 2022-03

Consulting • Healthcare • Logistics

Lifelancer is an AI-powered talent hiring platform that connects employers with skilled professionals in the Life Sciences, Pharmaceutical, and IT sectors. It enables individuals to create profiles showcasing their skills, get matched with high-paying international jobs or projects, and facilitates hiring and payroll for employers in multiple countries. The platform aims to streamline the hiring process with efficient AI sourcing and compliance support.

📋 Description

• Examine the appropriateness and medical necessity of requested healthcare services, including hospital admissions, procedures, tests, and therapies • Apply clinical guidelines, protocols, and evidence-based criteria to assess necessity and quality of healthcare services • Research opportunities to optimize resource utilization and promote cost-effective alternatives • Provide education and guidance to healthcare providers regarding utilization management processes, guidelines, and documentation requirements • Review medical records and analyze clinical data to determine alignment with established guidelines and standards • Communicate with healthcare providers, insurance companies, and other stakeholders regarding prior authorization needs • Conduct routine reviews to monitor patients’ ongoing care during hospital stays and treatment • Develop programs promoting quality effectiveness and optimized benefit utilization • Complete clinical reports, monitor key performance indicators, and track utilization management initiatives

🎯 Requirements

• Bachelor's degree preferred • Specialized training or relevant professional qualification • In-depth knowledge of clinical guidelines, protocols, and evidence-based criteria • Ability to review medical records and analyze clinical data • Ability to assess healthcare service necessity, quality, and guideline alignment • Ability to communicate with healthcare providers, insurance companies, and other stakeholders • Ability to complete clinical reports and monitor key performance indicators

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility