Job Description
- Minimum 1 year of experience using InterQual criteria
- At least 2 years of acute care bedside experience, preferably as an ER or ICU nurse
- Required experience in Utilization Management with a U.S.-based insurance company or hospital (or equivalent)
- Experience as a Team Lead or Supervisor in a similar support environment
- Strong clinical knowledge, particularly in:
- Medical necessity review
- Interpretation of clinical documentation
- Understanding of healthcare insurance processes
- Appeals, grievances, and utilization management (preferred)
- Amenable to work onsite
- Amenable to work on a night shift schedule
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