We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
Utilization Management Specialist
Location
United States
Posted
8 days ago
Salary
Not specified
Job Description
Role Description
This role involves supporting the clinical team by handling administrative and non-clinical tasks essential for processing Utilization Management prior authorizations and appeals. Your contributions will ensure the efficiency and accuracy of operations within the UM process.
- Monitor incoming faxes for authorization requests
- Enter UM authorizations review requests using ICD-10 and HCPCS codes
- Verify eligibility and claims history in proprietary platforms
- Ensure all necessary documentation is submitted with authorization requests
- Contact providers to obtain required medical records
- Generate correspondence for member and provider notifications
- Complete verbal notifications and document activities
- Initiate appeal cases for UM Nurses
- Meet deadlines for UM cases as per internal and regulatory standards
- Assist UM Nurses with designated tasks
- Handle inquiries from call center and other sources
- Perform other duties assigned by the UM Director
Qualifications
- 1 year as a UM Coordinator in a managed care payer environment preferred
- Knowledge of ICD-10, HCPCS codes, and medical terminology required
- Strong time management and organizational skills to prioritize tasks
- Proficient in computer applications like Word and Outlook
- Ability to collect data, analyze facts, and draw valid conclusions
- Effective written and oral communication skills required
- Experience with DMEPOS is desired
- Medicare/Medicaid experience is a plus
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance and short-term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO) and Paid Parental Leave
- Sick Time and Paid company holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Job Requirements
- 1 year as a UM Coordinator in a managed care payer environment preferred
- Knowledge of ICD-10, HCPCS codes, and medical terminology required
- Strong time management and organizational skills to prioritize tasks
- Proficient in computer applications like Word and Outlook
- Ability to collect data, analyze facts, and draw valid conclusions
- Effective written and oral communication skills required
- Experience with DMEPOS is desired
- Medicare/Medicaid experience is a plus
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance and short-term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO) and Paid Parental Leave
- Sick Time and Paid company holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
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Sr. Utilization Management Specialist
JobgetherWe use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
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