Pittsburgh , PA , United States
Perform utilization management / utilization review to assure medical necessity of services and care delivery in the appropriate setting as it applies to the clinical care of Health Plan members; Interacts with members providers and vendors on a daily basis; Collaborates with internal and external departments to ensure the consistent delivery of timely appropriate high quality healthcare.
Requirements: Bachelors Science Nursing Degree, InterQual experience a plus Registered Nurse license (or eligible) or equivalent experience; A minimum of five years of experience in a relevant clinical setting including direct experience with Managed Care utilization and Quality Improvement Working knowledge of computers required to include Microsoft Office Excellent interpersonal and organization skills Competent written and verbal communication skills Second language a plus but not required.
• EDUCATION: BS Nursing, Registered Nurse license
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