You are interested in working in a utilization management po

You are interested in working in a utilization management position with a managed care plan. What do you expect to find are the duties, educational background and experience in the job description?

Solution

Duties of utilization manager in healthcare sector:-

The utilization manager is responsible for assuring the receipt of high quality, cost efficient medical outcomes for those who are identified as having need for inpatient and outpatient. He should be able to implement scheduling of work in an effective manner.

Educational background and experience:-

1. Two year of prior experience with utilization management.

2. Previous training and demonstrated competence in negotiations, quality assurance, case management outcomes.

3. Masters degree in operations management.

Job description:-

1. Review the requests for medical necessity and referring them to medical director those that require additional expertise.

2. Review clinical information for concurrent reviews extending the length of stay for inpatients as appropriate.

3. Establish and effective reporting system.

4. Identify appropriate alternative and nontraditional resources and demonstrate creativity in managing each case to fully utilize the all available resources.

5. Prepare monthly cost saving and management reports.