Job Description:
• Provide operational and analytical support to Physician Advisory end-to-end clients
• Prepare and participate in client review meetings, including decks, data summaries, and presentations
• Track deliverables, timelines, and client escalations
• Support client onboarding processes and operational handoffs
• Analyze utilization data, case trends, and client performance metrics
• Investigate clinical and operational issues for end-to-end clients
• Prepare data-driven summaries and recommendations for leadership review
• Participate in evaluation of hospital utilization review processes and application of screening tools
• Support reporting infrastructure and PowerBI data validation
• Lead ad-hoc projects for end-to-end clients
• Provide support on time-sensitive deliverables and client requests
• Manage project timelines, resources, and stakeholder coordination
• Serve as operational point of contact for end-to-end clients
• Support escalation resolution and issue tracking
• Contribute to operational efficiency improvements
• Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards
• Comply with Information Security and HIPAA policies and procedures
• Limit viewing of protected health information to the minimum necessary
Requirements:
• Active RN license required
• Utilization Review experience required
• 4+ years of healthcare compliance and utilization review experience required
• 3+ years of project management experience required
• PM certification is a plus
• Proficiency with data analysis tools required
• MCG and IQ application expertise required
• End-to-end client or managed care operations experience
• PowerBI or data visualization experience preferred
• Proficiency in Microsoft Office Suite
• Strong interpersonal and communication skills
• Strong problem-solving and creative skills
• Ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability
• Strong sense of urgency and results orientation
• Excellent written and verbal communication skills required
• Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
• Ability to follow directions, collaborate with others, and handle stress
• Ability to perform the stated physical and computer-related duties
Benefits: