Overseeing utilization management functions, the full-time NY Licensed Clinical Utilization Manager will ensure high-quality, cost-effective member services while collaborating with care management teams and external medical providers in a remote setting. Key responsibilities Manage timely authorizations for pre-certification, concurrent reviews, and referrals Develop and monitor staff goals, providing feedback and conducting performance reviews Collaborate with medical staff to review charts and solve complex clinical problems Required qualifications Associate's degree RN or LPN clinical license preferred Experience in managed care and case management for high-risk populations Knowledge of CMS and NYSDOH regulations governing medical management Familiarity with utilization management philosophies and reporting requirements
NY Licensed Clinical Utilization Manager in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.