Job summary
Job post source
This job is directly from TriWest Healthcare Alliance.
Job overview
The Utilization Clinical Reviewer role involves reviewing and making decisions on the appropriateness of beneficiary care to ensure cost-effective resource utilization, applying clinical knowledge for preauthorization and continued stay reviews.
Responsibilities and impact
Daily responsibilities include conducting prior authorization, assessing medical necessity, preparing cases for review, and ensuring compliance with established criteria and regulations.
Compensation and benefits
The annual base salary for this position ranges from $73,000 to $93,000 depending on experience, along with comprehensive benefits including medical, dental, vision coverage, and a 401(k) plan with matching.
Experience and skills
Candidates must have an active RN license, U.S. citizenship, and at least 2 years of clinical and utilization management experience, with preferred qualifications including additional medical/surgical experience and familiarity with TRICARE.
Career development
Opportunities for professional growth include potential pay raises, overtime, and participation in recognition and reward programs.
Work environment and culture
TriWest Healthcare Alliance emphasizes teamwork, inclusivity, and a passion for serving others, fostering a supportive work environment.
Company information
Founded in 1996, TriWest Healthcare Alliance is dedicated to connecting America's heroes to healthcare in their communities, operating under a Department of Defense contract.
Team overview
The specific team dynamics and size are not detailed, but the role involves collaboration with clinical and non-clinical staff.
Job location and travel
This position offers remote work opportunities across various states, requiring a private workspace with high-speed internet.
Application process
Details on the application process, including documentation and deadlines, are not specified in the description.
Unique job features
The role distinguishes itself by its focus on serving military families and veterans, along with the opportunity to work in a fast-paced, impactful environment.
Company overview
TriWest Healthcare Alliance is a healthcare services company that administers health benefits for military veterans and their families. Established in 1996, TriWest partners with the U.S. Department of Veterans Affairs to manage the Veterans Choice Program and the Patient-Centered Community Care Program, ensuring access to quality healthcare services. The company generates revenue through government contracts and reimbursements for managing these programs. Key historical milestones include its pivotal role in expanding healthcare access for veterans, especially through the implementation of the Veterans Choice Program in 2014.
How to land this job
Tailor your resume to emphasize your active RN license, clinical experience, and specific utilization management experience, showcasing your ability to make informed decisions regarding beneficiary care.
Highlight your proficiency in Microsoft Office Suite and your effective communication skills, as these are vital for the role's responsibilities and interactions with clinical and non-clinical staff.
Apply through various platforms, including TriWest Healthcare Alliance's corporate site and LinkedIn, to broaden your application reach and visibility.
Connect with professionals in the clinical division at TriWest on LinkedIn, using ice breakers such as asking about their experiences at the company or discussing shared interests in healthcare management.
Optimize your resume for ATS by incorporating keywords from the job description, such as 'utilization management,' 'medical necessity,' and 'preauthorization,' to enhance your chances of passing initial screenings.
Utilize Jennie Johnson's Power Apply feature, which simplifies the application process by tailoring your resume, identifying the best application channels, and helping you network effectively, allowing you to focus on your job search.
Jennie Johnson works for you!
Here’s what we do to make sure you’re successful:
Targeted Resume Revamp:
We expertly craft your resume to navigate Applicant Tracking Systems (ATS) and showcase your qualifications, making you stand out as a top-tier candidate.
Job Description Dissection:
Unpack the job posting with expert analysis, ensuring your application hits every key requirement.
Bespoke Cover Letter:
Capture the attention of hiring managers with a personalized cover letter that highlights how your skills align perfectly with the job's needs.
Interview Mastery:
Prepare for interviews like a pro with likely questions, strategic answers, and insightful questions for you to ask, setting you apart as an informed candidate.
Direct Application Insights:
Receive tailored advice on the best places to apply, ensuring your applications are seen by the right employers.
Skills and Gaps Assessment:
Identify and close critical skills gaps to position yourself as the best-fit candidate for your ideal job.
Personalized Email Pitch:
Make a memorable first impression with an email template crafted to engage potential employers and initiate meaningful conversations.
In-depth Research Guide:
Leverage comprehensive research tools to gather effective insights on companies, industry trends, and role-specific challenges.
Detailed Company Analysis:
Gain in-depth understanding of your prospective employer, giving you the edge in applications and interviews.
Strategic Candidate Overview:
Understand your unique value and why companies would want to interview you, highlighting your background and positioning.