project manager in healthcare utilization management

Infinite Computer Solutions provides IT services and consulting, including healthcare utilization management solutions.

• Analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities;
• Document, review, and enhance utilization management processes, including intake, concurrent review, and appeals;
• Define business requirements for IT solutions;
• Conduct user acceptance testing for utilization management software;
• Ensure that utilization management processes comply with state and federal regulations and accreditation standards;
• Act as a liaison between clinical staff, including nurses and medical directors, and IT and leadership.

• 3–5+ Years of experience in utilization management, care management, or managed care settings;
• Strong SQL skills;
• Experience with data visualization tools such as Tableau and Power BI;
• Experience with electronic health records and electronic medical records;
• Deep understanding of healthcare coding, including ICD-10 and CPT;
• Knowledge of claims and insurance regulations;
• Bachelor’s degree in Healthcare Administration, Nursing, or a related field;
• BTECH;
• 8–12 Years of experience;
• Nice to have: RN or LPN license for clinical data interpretation.

• No conditions specified