Utilization Management Specialist

1 week ago


All India ASI-Apex Sourcing Full time ₹ 6,00,000 - ₹ 12,00,000 per year

Role Overview: As a Utilization Management Specialist, you play a crucial role in ensuring the efficient delivery of healthcare services while maintaining high-quality standards and adhering to organizational policies and regulatory requirements. Your responsibilities include reviewing medical records, coordinating care, and collaborating with healthcare providers to manage patient treatment plans cost-effectively. Key Responsibilities: - Evaluate the medical necessity, appropriateness, and efficiency of healthcare services through pre-certification, concurrent, and retrospective reviews. - Ensure compliance with relevant guidelines and regulations, advocate for optimal patient outcomes, and manage resource utilization effectively. - Maintain accurate documentation of reviews, authorizations, and patient information. - Prepare reports on utilization trends, compliance issues, and quality metrics. - Educate patients and providers about treatment options, insurance requirements, and care pathways. - Resolve disputes related to denied claims or coverage issues. - Work in night shifts and potentially with an insurance company or managed care setting. Qualifications Required: - Bachelor's degree in any field years of relevant experience. - Strong skills in medical terminology, clinical practices, and healthcare regulations. - Proficiency in electronic medical records (EMRs) and utilization management software. - Excellent communication, problem-solving, and decision-making abilities. Additional Details: Joining our team in Mohan Cooperative, New Delhi, you will enjoy the perks and benefits of a competitive industry package.,


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