Job Summary
A software development company is seeking a Remote Payer Utilization Management Analyst in Chicago.
Core Responsibilities of this position include:
- Analyzing MCG care guidelines, categorizing requirements into classes and creating decision trees
- Taking complex clinical information and distilling it into simple, clear questions
- Working with a nurse reviewer and physician reviewer to modify/improve work
Applicants must meet the following qualifications:
- Experience within utilization management from health plans/payers
- Understands how requirements are applied to Approve/Deny/P2P
- Commercial experience and Medicare/Medicaid including understanding of NCD/LCD
- Comfortable with ambiguity and able to design organized approaches to address
