Jun 11, 2017

Utilization Management Specialist

  • MyNexxtJob
  • Pittsburgh, PA , United States
Full time Health Care

Job Description

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.

Job 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


Employee Health Manager



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