Date Open: July 5, 2020
Date Closed: –
Description: Utilization Management Specialist, Healthcare
Department: Milliman Care Guidelines Clinical Team
The team is looking to recruit a Utilization Management Specialist for Riyadh market to support implementation and training on clinical guidelines for utilization management across various healthcare providers and payers within KSA.
The environment is fast paced and innovative. Our team is highly self-directed. We are looking for others to join us who will take ownership of responsibility, work collaboratively and always look for ways to add to the personal and professional growth of the company and their peers.
The successful candidate should have rich clinical experience, awareness of the GCC healthcare delivery system and payer market concepts, good understanding of medical coding. This professional also needs excellent presentation and communication skills and has conducted training for clinical staff on a variety of matters, such as factors affecting the facility’s service-improvement programs. Good assessment, analytical and computer skills are also crucial.
As a UM nurse, this professional will join our team to assist in all phases of setting up clinical guidelines and utilization management function across various healthcare facilities and payers organizations within KSA. We are looking for a person with ability to:
• Collaborates with clinical team, IT team and leadership to work on projects, influence change management, drive training strategy and coordinate project roll outs.
• Develop training strategies and delivering training on proper access and use of clinical guidelines to various clinical and non-clinical groups.
• Utilizes enterprise Learning Management System to share training resources and information, training materials, track training activity, report on progress, and support implementation live cycle.
• Supports the utilization management guideline implementation process
• Provides instruction for both newly hired clinical staff, staff being cross-trained on other accounts, and sustainment training for existing staff.
• Work both independently and in a cross-functional team environment.
• Work independently on assigned tasks, i.e. plan, organize, delegate, problem solve and meet established deadlines
• Ability to travel across various regions within KSA.
• Ability to learn value driven new healthcare concepts and undergo formal certifications for knowledge assessment.
Skills and Requirements
Utilization Review Nurse is a specialized work, a person at this position must be team players with excellent interpersonal skills. This position requires the following minimum requirements:
• Graduated from Bachelor of Science in Nursing or higher and is currently a registered nurse
• Minimum 10 years of work experience in a multispecialty hospital as nurse, with exposure to various clinical departments.
• Excellent understanding of patient’s journey within a healthcare system across different care settings, such as; inpatient, outpatient and other allied services.
• Excellent clinical knowledge and ability to read and accurately interpret complex medical records.
• Good knowledge on administrative work and hospital procedures.
• Experience demonstrating ability to design and drive training programs.
• Excellent understanding on international medical coding systems (such as ICD10, ACHI, CPT Etc.).
• Proficient in MS/Word, Excel, PowerPoint.
• Fluent in Arabic and English speaking and writing skills.
• ICD 10-AM and ACHI coding knowledge;
• Experience of working in a utilization management process;
• Relevant work experience and in depth understanding on different healthcare systems across GCC countries
• Frequently conducted various training programs within hospital setting
Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in healthcare, property & casualty insurance, life insurance and financial services, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe.
Interested candidates should email their resume to Rana.Alhumaid@miliman.com