01Responsibilities
- Utilization Review:
- Evaluate the medical necessity, appropriateness, and efficiency of healthcare services.
- Conduct pre-certification, concurrent, and retrospective reviews of care.
- Ensure compliance with applicable guidelines and regulations.
- Case Management Coordination:
- Collaborate with healthcare providers, payers, and patients to coordinate care and services.
- Advocate for optimal patient outcomes while managing resource utilization.
- Documentation and Reporting:
- Maintain accurate and up-to-date records of reviews, authorizations, and patient information.
- Prepare reports on utilization trends, compliance issues, and quality metrics.
- Policy Compliance:
- Ensure adherence to organizational policies and external regulatory standards.
- Stay updated on industry standards and best practices in utilization management.
- Patient and Provider Communication:
- Educate patients and providers about treatment options, insurance requirements, and care pathways.
- Resolve disputes related to denied claims or coverage issues.
- Candidates should be open to working in night shift
- No cab .
