Hollywood , FL , United States
Provide utilization management / utilization reviews to assure medical necessity of services and care delivery in the appropriate setting as it applies to the clinical care of Health Plan members - Interact with members providers and vendors on a daily basis - Collaborate with internal and external departments to ensure the consistent delivery of timely appropriate high quality healthcare.
Requirements: -A minimum of five years of experience in a relevant clinical setting including direct experience with Managed Care utilization and Quality Improvement -InterQual experience a plus -Working knowledge of computers required to include Microsoft Office -Excellent interpersonal and organization skills -Competent written and verbal communication skills
• EDUCATION: Bachelors Science Nursing Degree (foreign degrees accepted) State Registered Nurse license eligible with equivalent experience
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