Deskripsi Pekerjaan
Join our dynamic team at Sales Rain BPO Inc. as a Utilization Management Coordinator and play a crucial role in optimizing healthcare delivery while ensuring cost-effective patient care. In this position, you'll apply your medical knowledge and analytical skills to review healthcare services, ensuring they meet clinical necessity criteria and align with established protocols.
As a key member of our healthcare management team, you'll collaborate with medical professionals, insurance providers, and healthcare facilities to coordinate appropriate patient care pathways. Your expertise will help balance quality healthcare outcomes with efficient resource utilization, making a significant impact on patient satisfaction and operational efficiency.
We offer a supportive work environment where your professional growth is nurtured through continuous learning opportunities and mentorship. If you're passionate about healthcare administration and possess strong analytical abilities, we encourage you to apply for this rewarding position that bridges clinical expertise with operational excellence.
Tanggung Jawab
- Apply medical necessity screening criteria to determine appropriateness of admissions and length of stays
- Review patient cases against clinical guidelines and established protocols
- Coordinate with healthcare providers to ensure optimal patient care pathways
- Document case reviews and maintain accurate records of utilization management decisions
- Collaborate with insurance companies and healthcare facilities to resolve discrepancies
- Analyze healthcare data to identify trends and opportunities for process improvement
- Stay updated on healthcare regulations, policies, and best practices in utilization management
Kualifikasi
- Bachelor's degree in Nursing, Healthcare Administration, or related field
- Previous experience in utilization management, healthcare coordination, or similar role
- Strong understanding of medical terminology and clinical criteria
- Excellent analytical and decision-making skills
- Effective communication and interpersonal abilities
- Proficiency in healthcare management software and data analysis tools
- Certification in utilization management or healthcare administration (preferred)