UM Clinical Reviewer Senior Analyst

Overview

Employer Industry: Healthcare Services

Why consider this job opportunity:

• Salary up to $52/hour
• Eligible for participation in an annual bonus plan
• Comprehensive benefits package including medical, vision, and dental coverage, starting on day one
• Minimum of 18 days of paid time off per year plus paid holidays
• Opportunity for professional growth and development within the organization
• Supportive work environment focusing on whole health

• Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage
• Apply clinical policies and national guidelines to make authorization decisions
• Identify cases requiring physician review and coordinate with Medical Directors
• Initiate Case Management referrals as appropriate
• Maintain compliance with HIPAA and internal quality standards

• Registered Nurse (RN) with multistate license in good standing
• Minimum 3 years of RN experience in managed care, utilization management, or prior authorization
• Strong analytical, communication, and decision-making skills
• Proficiency with Windows, Word, and care management platforms
• Ability to manage multiple tasks and adapt to a fast-paced environment

• Bachelor of Science in Nursing (BSN)
• Experience with quality audits and workflow improvements
• Familiarity with MCG, ASAM, and URAC standards
• Excellent customer service skills
• Experience in a clinical decision-making role

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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.