Remote Healthcare administration Jobs • Utilization Management

The Utilization Management Clinical Specialist will play an important role in SmarterDx’s next product launch in the Utilization Management and Case Management space. This role will work closely with Product and Data Science to design and refine strategies that help hospitals optimize resource use, ensure appropriate levels of care, and support timely and effective patient management. The specialist will bring a clinical and operational view to patient status determination, documentation workflows, and utilization review, contributing to AI tools that support care coordination and medical necessity compliance.

Applies Case Management principals in coordinating patient care across the continuum using assessment , care planning, implementation , coordination, monitoring and evaluation for cost effective and quality outcomes in a primarily inpatient setting, including complex discharge planning . Performs Utilization Management clinical review to ensure that services rendered to members meet clinical criteria and are delivered in the appropriate setting.