Summary of Job Duties & Responsibilities:
This position performs the daily medical utilization activities of the health plan and acting as a liaison between medical providers, both on-island and off-island. Under the direction of the Manager of Medical Management, the Medical Case Reviewer will take responsibility for the daily management of prospective, concurrent and retrospective utilization reviews, including referrals and pre-certification, case management, hospital claims review; generate utilization reports as required.
Education and experience requirement, with an RN or M.D. Degree in Medicine; preferred Doctor of Medicine or Registered Nurse. The candidate must have at least one year professional work experience in a health care setting. Has knowledge or experience with health insurance/HMO/PPO operations and managed care utilization techniques. Proficient in using computer programs. Must be an excellent communicator, verbally and in writing.
Equal Employment Opportunity Employer
All applications will be considered solely on the basis of qualifications and ability, as the company does not unlawfully discriminate from consideration for employment on a basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, veteran status, or any other protected status under applicable local and federal laws.
Please email your resume/work experience by using the apply link below.
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