Job added in hotlist
Applied job
Contract job
Recruiter job
Employer job
Expanded search
Apply online not available
View more jobs in Kapolei, HI
View more jobs in Hawaii

Job Details

We're Sorry..

The job you clicked on has expired or has been removed and is no longer available. The original listing can be found at the bottom of the page for your reference.

New Search

Utilization Review- QUEST

This job is expired..
Kapolei, HI


The Utilization Review Clinician for the QUEST population is responsible for the utilization management, utilization review and/or concurrent review of inpatient cases to determine medical appropriateness of inpatient and intermediate levels of care following clinical guidelines and benefit determination.

Job Requirements


Utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical criteria, and benefit information and provide consultation and responses to utilization management requests. Complete clinical reviews and apply utilization review criteria for patient admissions and various levels of care and/or continued stay reviews and/or discharge planning. Participate in the identification of specialized clinical programs (new diversionary services) to address unmet needs in the network. Discuss cases with treating clinicians and other healthcare professionals as needed. Identify and monitor trends in utilization and quality metrics as needed. Collaborate with colleagues to establish workflows for overall management of high risk members including case management referrals, discharge planning and aftercare. Monitor productivity standards daily. Maintain thorough knowledge of covered benefits for the populations served. Participation in NCQA and URAC activities, as assigned. Other duties as assigned.


Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information and facilitate care in multiple settings. Demonstrated work experience applying analytic and critical thinking skills. Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes. Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills.


College Degree

Graduate Degree

Current, valid and unrestricted Hawaii licensure for practice required with proof on date of hire. Re-verification will take place no less than every 3 years.

Current, valid and unrestricted licensure for practice required with proof on date of hire. Re-verification will take place no less than every 3 years.

Required to be educated in current principles, procedures and knowledge of behavior health. They must be an independently licensed behavioral health clinician and practice within the scope of their licensure with a minimum of 10 years behavioral health /managed care experience

Company info

Beacon Health Strategies, LLC
Website :

I was very pleased with the AuditorCrossing. I found a great position within a short amount of time … I definitely recommend this to anyone looking for a better opportunity.
Jose M - Santa Cruz, CA
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
AuditorCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
AuditorCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2018 AuditorCrossing - All rights reserved. 21