UM - Fresher

SHAI Health; Chennai District; On-site; INR 450,000 - 650,000; Full time

Job summary

Zoho is seeking a motivated and detail-oriented Utilization Management Specialist to join our team. As a fresher in this role, you will review medical information to ensure that healthcare services are necessary and align with best practices.

You'll support prior authorizations, collaborate with providers and clinical staff, and help monitor utilization trends to drive cost-effectiveness and patient care. Fresh graduates with a Bachelor’s in Nursing are encouraged to apply; prior hospital field

Qualifications

• Bachelor's Degree in Nursing required or eligible to apply.
• Freshers can apply.
• Experience in a hospital field is an added advantage.

Responsibilities

• Review outpatient procedures, inpatient admissions, home health, and behavioral health services to assess necessity.
• Collaborate with providers and medical directors to obtain prior authorization and plan case reviews.
• Work with clinical staff to ensure appropriate care and resource use.
• Participate in quality improvement projects and help develop clinical guidelines.
• Monitor and report utilization trends to management.

Skills

Guidelines familiarity

Regulatory knowledge

Medicaid/Medicare experience

Anatomy knowledge

Communication skills

Analytical thinking

Education

Bachelor's Degree in Nursing

Job description

Job Description:

We are looking for a motivated anddetail-oriented Utilization Management Specialist to join our team. As afresher In this role, you will help review medical information to ensure thathealthcare services are necessary and follow best practices. You will supportthe approval of healthcare services to ensure they are cost-effective and meetpatient needs.

Preferred Skills

• Familiaritywith MCG/Inter Qual Guidelines is a plus.
• Keepup-to-date with regulations and maintain organized records of all activities.
• Experiencewith Medicaid, Medicare, and Managed Care is helpful.
• Strongknowledge of anatomy, physiology, and medical terminology.
• Excellentcommunication skills and ability to work both independently and in a team.
• Stronganalytical and problem-solving skills.

Requirements

Key Functions:

• Reviewoutpatient procedures, inpatient admissions, home health, and behavioral healthservices to check if they are necessary.
• Workwith providers and medical directors to get prior authorization and plan forcase reviews when needed.
• Collaboratewith clinical staff to ensure appropriate care and resource use.
• Participatein quality improvement projects and help develop clinical guidelines.
• Monitorand report on utilization trends to management.

Qualifications :

Candidateswith a Bachelor's Degree in Nursing are eligible to apply

Freshersalso can apply.

Candidatesalready having work experience in a Hospital Field is an added advantage.