Maharani Bagh Delhi Delhi Specialist managed services Jobs – 55 Open Jobs Today

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Utilization Management Specialist

ASI-Apex Sourcing
Delhi, Delhi

Apply Now

Job details

Benefits

Commuter assistance

Qualifications

Bachelor's degree
EMR systems
Medical terminology
Billing
Communication skills

Full job description

Utilization Management Specialist

Location: Mohan Cooperative, New Delhi

Required Experience: 2 - 5 years

Required Qualifications

Bachelor’s degree in any field
Experience with insurance providers, hospital administration, or managed care organizations is desirable

Skills and Competencies:

Strong understanding of medical terminology, clinical practices, and healthcare regulations (e.g., CMS, HIPAA)
Proficiency in electronic medical records (EMRs) and utilization management software
Excellent communication, problem-solving, and decision-making abilities
Ability to analyze and interpret clinical data effectively
Knowledge of payer systems, billing processes, and managed care principles

Work Environment:

May involve working closely with an insurance company / managed care setting
Work from office / US hours

Perks and Benefits: Best in industry

Job description

The Utilization Management (UM) Specialist ensures that healthcare services are delivered efficiently and meet quality standards while aligning with the organization’s policies and regulatory requirements. The role involves reviewing medical records, coordinating care, and working with healthcare providers to manage patient treatment plans in a cost-effective manner.

Responsibilities:

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

Apply Now

Refine Your Search

specialist managed services jobs in maharani bagh delhi delhi

Utilization Management Specialist

Travel Consultant

Networking Account Manager - Public/ Government Sector

Technical Specialist MS - Systems

Senior Backend & Cloud Engineer

CX Solutions Consultant

Sr. Manager MOD Execution

Occupational Health Nurse

Senior Frontend Engineer (SFCC & PWA Kit)

Engineer - Stormwater Modeller ICM

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