Utilization Management Associate

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide administrative support to the Utilization Management program within the Utilization Review department.

• Conduct intake, screening, and precertification for appropriate healthcare services.

• Aid Clinical Care Nurses with clerical duties related to discharge planning and utilization review.

• Oversee member eligibility monitoring.

• Make outreach calls to hospitals to gather follow-up clinical and discharge information.

• Manage new admissions by updating patient demographics, creating cases in BabyTrax®, documenting cases in the client system, and assigning Clinical Care Nurses.

• Communicate verbal and written prior authorizations in line with client specifications.

• Handle incoming Utilization Management calls and direct them to the relevant staff.

• Ensure compliance with policies, procedures, regulations, patient safety, risk management, and accreditation standards.

• Maintain precise and comprehensive documentation.

• Offer additional support and engage in project work across Care Management as necessary.

• Report directly to the Supervisor of Utilization Review.

⛳️ Requirements

• 1–3 years of experience in customer service within a healthcare setting.

• High school diploma or equivalent is required.

• A college degree is preferred.

• Experience with insurance/payor is preferred.

• Familiarity with healthcare terminology is essential.

• Professional verbal and written communication skills are required.

• Problem-solving abilities with the capacity to identify root causes and implement effective solutions.

• Intermediate to advanced skills in Outlook, Excel, PowerPoint, and Word.

• Fluency in English is mandatory.

• Proficiency in a second language is highly desirable.

• Self-motivated and eager to learn multiple tasks.

• Well-organized with the ability to prioritize tasks effectively.

• Commitment to providing excellent customer service.

🏝️ Benefits

• Paid Time Off.

• Paid Parental Leave.

• Medical, dental, and vision benefits.

• 401K plan with company match.

• Short- and Long-Term Disability coverage.

• Group Life Insurance.

• Tuition reimbursement.

• Opportunities for professional development.