Nursing Graduates for Utilization Management
Specialist/Prior Authorization Specialist
Job Title: Utilization
Management Specialist/Prior Authorization Specialist
Job Description:
We are looking for a motivated and
detail-oriented Utilization Management Specialist to join our team. As a
fresher In this role, you will help review medical information to ensure that
healthcare services are necessary and follow best practices. You will support
the approval of healthcare services to ensure they are cost-effective and meet
patient needs.
Preferred Skills
ü Familiarity
with MCG/Inter Qual Guidelines is a plus.
ü Keep
up-to-date with regulations and maintain organized records of all activities.
ü Experience
with Medicaid, Medicare, and Managed Care is helpful.
ü Strong
knowledge of anatomy, physiology, and medical terminology.
ü Proficient
in MS Office applications.
ü Excellent
communication skills and ability to work both independently and in a team.
ü Strong
analytical and problem-solving skills.
Requirements
Key Functions:
ü Review
outpatient procedures, inpatient admissions, home health, and behavioral health
services to check if they are necessary.
ü Work
with providers and medical directors to get prior authorization and plan for
case reviews when needed.
ü Collaborate
with clinical staff to ensure appropriate care and resource use.
ü Participate
in quality improvement projects and help develop clinical guidelines.
ü Monitor
and report on utilization trends to management.
Qualifications :
Candidates
with a Bachelor's Degree in Nursing are eligible to apply
Freshers
also can apply.
Candidates
already having work experience in a Hospital Field is an added advantage.
Skills Required
- Bachelor’s Degree in Nursing
- Strong knowledge of anatomy, physiology, and medical terminology
- Excellent communication skills
- Ability to work independently and in a team
- Strong analytical and problem-solving skills
- Proficiency in Microsoft Office applications
- Familiarity with MCG or InterQual Guidelines
- Experience with Medicaid, Medicare, and managed care
- Hospital field work experience
What We Do
SHAI is a technology-enabled healthcare services provider focused on Revenue Cycle Management (RCM) for the US healthcare sector. It combines proprietary technology, industry expertise, and efficient processes to help medical billing companies, physician groups, and hospitals optimize revenue, reduce claim denials, and maintain compliance. The company supports healthcare organizations in navigating complex financial and operational challenges.
