Responsible for utilization management / utilization review of activities to assure that facility provides the necessity medical services and care delivery to the appropriate patients, and Health Plan members
- Will interact with members providers and vendors on a daily basis - Will 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 - Direct experience in Managed Care utilization and Quality Improvement - >InterQual 2018 experience a plus - Excellent interpersonal and organization skills - Competent written and verbal communication skills, second language a plus
• EDUCATION: Bachelors Science Nursing, Degree, Registered Nurse New York City license (or eligible) or equivalent experience
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