Health Services - Utilization Management Specialist

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.



Job Title: Health Services - Utilization Management Specialist.

Location: Baltimore, MD.



 

Purpose:

• Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage.


• Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical policy, evidence-based published research, national accreditation and regulatory requirements contribute to determination of appropriateness and authorization of clinical services both medical an...