Utilization Case Manager (Remote)
Core
Review clinical utilization and authorize continued care to ensure optimal patient outcomes and avoid treatment delays.
Role type
Utilization Case Manager
Builds
Patient care continuity and authorization workflows
Domain
Healthcare administration / Insurance utilization management
Deliverable
client delivery
Required skills
Clinical utilization review, authorization process management, payer policy knowledge, interdepartmental communication, treatment plan analysis, benefits coverage verification
Preferred skills
None stated
Technologies
None stated
Responsibilities
Perform timely reviews for services requiring authorization for continuation of care; Follow established payer or clinical guidelines for the authorization process; Review coverage benefits and limitations to determine appropriateness of requested services; Facilitate communication regarding authorization status to the clinical team and patients; Identify potential treatment delays by reviewing treatment plans and communicate barriers; Maintain knowledge of payer reimbursement policies and clinical guidelines.
Seniority
Mid-level, hands-on IC