Utilization Management Support Specialist I

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures. Supports the scheduling of reviews, communicating the results and completing the required verbal and written correspondence.

Assists in the physician advisor process for cases sent for peer-to-peer review. Supports the scheduling of reviews, communicating the results and completing the required verbal and written correspondence.

• Researches cases referred to peer review and contacts the facility to schedule a physician-to-physician review. Documents task completion in applicable internal systems. Prepares administrative, approval and clinical denial letters as assigned. Reviews completed denial letters to ensure accuracy, template use and within the appropriate grade level. May be asked to take calls from the designated phone queue when needed. (70%)
• Identifies risk situations and escalates to supervisor as appropriate. (10%)
• Troubleshoots issues noted within case by coordinating with internal departments, team members and physicians. Consults with internal departments to ensure cases meet guidelines. (10%)
• Assists in the mentoring and training of new UM Support Specialists. (10%)

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Responsibilities
Experience in customer interactions and detailed review of health-related materials.
Strong interpersonal skills and attention to detail.
Ability to organize work and seek help on tasks where needed.
Ability and willingness to learn new software applications.
Strong writing and proofreading skills required ensuring documents meet standards and are accurate.
Experience in Microsoft Office suite applications.
Strong time management skills.
Strong analytical skills.

General Job Information

Title
Utilization Management Support Specialist I

Grade
19

Work Experience - Required
Healthcare

Work Experience - Preferred

Education - Required

Education - Preferred
Associate - Business Administration

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:
$37,725
Salary Maximum:
$56,595

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.