Mass Utilization Review Specialist

Job Summary

A company is looking for a Mass Utilization Review professional.

Key Responsibilities

• Facilitate resource coordination to help patients achieve optimal health and access to care
• Manage the medical necessity process for accurate and timely payment for services
• Ensure compliance with regulatory requirements and provide education on covered services

Required Qualifications

• Associate's Degree or College Diploma
• Experience in utilization management or case management
• Knowledge of state and federal regulatory requirements
• Familiarity with payer negotiation processes
• Understanding of TJC accreditation standards