Senior Utilization Review Coordinator - Remote Healthcare
Integrated Management Strategies
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Descrizione del lavoro
Integrated Management Strategies (IMS) is seeking an experienced Sr Review Coordinator to join our healthcare consulting practice. This role is fully remote within the US and focuses on utilization review of plans of service for home and community-based programs, impacting access to services for the MD population.
You will review complex plans, act as a resource for non-clinical reviewers, and ensure timely, quality decisions in line with contract, state, and URAC requirements.
Competenze
- Active Maryland RN License (OR) Social Worker License
- 3–5 years of recent clinical experience
- Ability to maintain regular and predictable attendance
- Good written and oral communication skills
- Up to 5% local travel
Mansioni
- Perform utilization review of plans of service for home and community-based programs
- Review complex plans of service and assist non-clinical reviewers
- Provide independent review decisions for behavioral health services and quality of care
- Screen cases according to criteria to determine care appropriateness
- Ensure reviews are thorough and timely
- Serve as liaison among providers, facilities, and subscribers
- Document medical information supporting decisions in the system
Conoscenze
Formazione
Descrizione del lavoro
Integrated Management Strategies (IMS) is seeking an experienced Sr Review Coordinator to join our healthcare consulting practice. This role is fully remote within the US and focuses on utilization review of plans of service for home and community-based programs, impacting access to services for the MD population.
You will review complex plans, act as a resource for non-clinical reviewers, and ensure timely, quality decisions in line with contract, state, and URAC requirements.
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