Full-time jobs in Dallas, TX

About the role

This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers and facilities.

What you'll bring

• Candidates must be based in TX.
• 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
• Knowledge of medical terminology and procedures.
• Verbal and written communication skills.
• Utilization management experience
• MCG or InterQual experience