Utilization Management Specialist

This is a fully remote position, open to applicants in Arizona, +7 more states.

📋 Description

• Manage a designated portfolio of cases in collaboration with UR Nurses.

• Prepare and compile clinical review packets along with necessary documentation for payer submissions.

• Review records to ensure all required documentation is present and elevate any gaps to the assigned UR Nurse.

• Monitor submission confirmations and follow up on outstanding payer determinations.

• Oversee authorization lifecycles, which encompass entry, tracking, follow-up, documentation, and monitoring payer response timelines.

• Keep an eye on payer portals and reach out to payers for authorization updates and to address any discrepancies.

• Prioritize cases based on deadlines, risks of authorization expiration, and regulatory timeframes.

• Raise urgent authorization concerns, delays, or obstacles.

• Coordinate logistics for peer-to-peer scheduling and maintain related documentation.

• Document and relay payer determinations within EPIC/CS-Link.

• Identify systemic issues in authorization workflows and communicate trends to UM leadership.

• Ensure that all necessary documentation is accurately inputted into EPIC/CS-Link.

• Engage with internal and external partners to keep patient and authorization information current and comprehensive.

⛳️ Requirements

• A high school diploma or GED is mandatory.

• An associate's degree or college diploma in business, health, or a related field is preferred.

• A minimum of 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes is required.

• Experience in independently managing authorization workflows is highly preferred.

• At least 2 years of acute care experience is preferred.

• Approved states for remote work include Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, and Texas.

🏝️ Benefits

• Health care coverage.

• Paid time off.

• 403(B) retirement plan.

• Competitive salary packages.

• Health and dental insurance options.

• A dynamic and inclusive work environment.