Outpatient UM Clinician

This is a fully remote position, open to applicants in California.

📋 Description

• Perform utilization reviews for outpatient services to ensure adherence to standards.

• Collaborate with healthcare providers to evaluate patient needs and treatment plans.

• Record and monitor patient progress along with treatment outcomes.

• Liaise with insurance companies regarding authorizations and appeals.

• Offer education and support to patients and their families concerning care options.

• Engage in quality improvement initiatives to enhance service delivery.

• Keep abreast of industry regulations and best practices in utilization management.

• Support the training and mentoring of new staff on UM processes.

⛳️ Requirements

• Licensed clinician with experience in nursing, social work, or a related discipline.

• At least 2 years of experience in utilization management or case management.

• Strong knowledge of healthcare regulations and insurance procedures.

• Exceptional communication and interpersonal abilities.

• Capability to work collaboratively in a dynamic environment.

• Proficient in electronic health records and documentation practices.

• Detail-oriented with robust analytical and problem-solving capabilities.

• Dedication to patient-centered care and quality enhancement.