Utilization Management Specialist

Immediate need for a talented Utilization Management Specialist. This is a 06+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-34319

Pay Range: $24/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• Conduct non-clinical reviews based on applicable criteria and guidelines on requested services.
• Communicate decisions to providers and/or members according to department protocols.
• Document outcomes of reviews and demonstrate the ability to interpret and analyze non-clinical information.
• Complete verbal or non-verbal outreach to providers or members to obtain medical information for reviews.
• Identify and refer organization determinations that require a clinical review to a nurse or Medical Director.
• Conduct reviews of authorizations entered to ensure accuracy to avoid impacting claims payment.
• Support the care management department by completing outreach to meet CMS requirements.
• Assist the administrative support team with the retrieval and attachment of facsimiles for customer requests.
• Serve as a subject matter expert for CM&O around the non-clinical review process.

Key Requirements and Technology Experience:

• High school diploma or GED.
• 3+ years of experience in a related field.
• Experience in retail pharmacy and Medicare.
• Strong communication skills and attention to detail.

Our client is a leading Insurance Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
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