At least 1 year Utilization Management, Prior Authorization, or Post Service Clinical Claims Review (PSCCR) account experience is an advantage. Requires current active unrestricted USRN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States. Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.