Description
The Case Management Utilization Review Specialist manages high-cost and high-risk insurance cases, coordinates with case management, providers, vendors, and payers, audits savings reports, manages Jumbo discounts, resolves disputed and pending cases, and investigates provider or clinician abuse and medical negligence. The role requires an MBBS degree, at least five years of medical practical experience, fluency in Microsoft Office, and the ability to work in an AI-enabled environment using data analytics and cloud-based tools.
