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Associate Utilization Review Specialist - Remote

Providence St. Joseph Health

Renton, WA(remote)

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JOB DETAILS
JOB TYPE
Full-time, Employee
SKILLS
Adjudication, Best Practices, CIM (Common Information Model), Call Center Telephony, Call Volume, Communication Systems, Consulting, Current Procedural Terminology (CPT), Customer Support/Service, Database Administration, Database Technology, Diversity, Establish Priorities, Federal Laws and Regulations, Genetics, Health Information Management, Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Maintenance Services, Metrics, Operations Planning, Problem Solving Skills, Quality Metrics, Registered Nurse (RN), Regulations, Regulatory Compliance, Research Skills, Spreadsheets, Systems Administration/Management, Utilization Management, Work From Home
LOCATION
Renton, WA
POSTED
30+ days ago
Description

Associate Utilization Review Specialist - Remote

Providence Health Plan is calling an Associate Utilization Review Specialist who will:

Be responsible for all core functions in the Prior Authorization (PA) Department

Coordinate and execute the review and research functions required to support the PA Department

Investigate, review, and prepare all requests for prior authorization review for all lines of business (LOB) in multiple applications (Facets, CIM, CareAdvance, etc.) while using multiple resources to support the review (Medical Policies, KMS, Benefit Grids, Handbooks, etc.)

Critically assess and prepare all cases for RN/MD review of coverage (medical necessity, eligibility, network status, regulatory)

Uses appropriate resources and sound judgement to review and approve specific service requests based on deep understanding of medical service requested, CPT/HCPCS codes, and plan design. Authorizes select medical services

Provide research, assessment, and proposed resolution of operational issues as they relate to coverage policy, correct coding (CPT/HCSPCS, Dx), regulations, and other coverage rules

Take incoming phone calls from providers and members regarding operational plan functions with an ability to research and follow-up on unique prior authorization related requests and plan processes for all lines of business

Responsible for ensuring service review requests and inquiries are complete and adjudicated to meet regulatory and compliance requirements, including timeliness

Consult, or triage to, appropriate subject matter experts internally and across departments

Work in a fast-paced environment with strict compliance and turn-around-times for all work metrics (prior authorization requests, customer service inquiries, provider resolutions, etc.)

Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

This position offers 100% remote work and is open to candidates residing in:

Oregon

Washington

California

Required Qualifications:

Bachelor's Degree in Health related field., Or Applicable 2 years work experience may be substituted for some education.

2 years experience in healthcare related field (or equivalent education)

1 year experience and proven track record of researching and resolving complex problems which required critical thinking

2 years experience in fast-paced working environment with a proven record of successful ability to quickly prioritize and resolve issues to meeting timeliness and quality metrics.

1 year experience in database management and spreadsheets.

6 months experience with telephony systems, call center phone volumes and multi-line communication systems.

Preferred Qualifications:

3 years experience in healthcare related field (or equivalent education)

Salary Range by Location:

California: Humboldt: Min: $29.62, Max: $45.31

California: All Northern California - Except Humboldt: Min: $33.23, Max: $50.84

California: All Southern California - Except Bakersfield: Min: $29.62, Max: $45.31

California: Bakersfield: Min: $28.41 Max: $43.47

Oregon: Non-Portland Service Area: Min: $26.49, Max: $40.52

Oregon: Portland Service Area: Min: $28.41 Max: $43.47

Washington: Western : Min: $29.62, Max: $45.31

Washington: Southwest - Olympia, Centralia & Below: Min: $28.41 Max: $43.47

Washington: Eastern: Min: $25.28, Max: $38.68

Washington: South Eastern: Min: $26.49, Max: $40.52

Why Join Providence Health Plan?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Requsition ID: 418213

Company: Providence Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Business Professional

Department: 5018 HCS MEDICAL MANAGEMENT OR REGION

Address: OR Portland 4400 NE Halsey St

Work Location: Providence Health Plaza (HR) Bldg 1-Portland

Workplace Type: Remote

Pay Range: $see posting - $see posting

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

About the Company

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Providence St. Joseph Health