UM - Fresher

Nursing Graduates for Utilization Management Specialist/Prior Authorization Specialist

Job Title: Utilization Management Specialist/Prior Authorization Specialist

Job Description:
We are looking for a motivated and detail-oriented Utilization Management Specialist to join our team. As a fresher In this role, you will help review medical information to ensure that healthcare services are necessary and follow best practices. You will support the approval of healthcare services to ensure they are cost-effective and meet patient needs.

Preferred Skills

Familiarity with MCG/Inter Qual Guidelines is a plus.

Keep up-to-date with regulations and maintain organized records of all activities.

Experience with Medicaid, Medicare, and Managed Care is helpful.

Strong knowledge of anatomy, physiology, and medical terminology.

Proficient in MS Office applications.

Excellent communication skills and ability to work both independently and in a team.

Strong analytical and problem-solving skills.

Key Functions:

Review outpatient procedures, inpatient admissions, home health, and behavioral health services to check if they are necessary.

Work with providers and medical directors to get prior authorization and plan for case reviews when needed.

Collaborate with clinical staff to ensure appropriate care and resource use.

Participate in quality improvement projects and help develop clinical guidelines.

Monitor and report on utilization trends to management.

Qualifications :

Candidates with a Bachelor's Degree in Nursing are eligible to apply

Freshers also can apply.

Candidates already having work experience in a Hospital Field is an added advantage.