Utilization Management Support Specialist I

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

📋 Description

• Assist in the physician advisor process for cases submitted for peer-to-peer review.

• Support the scheduling of reviews, communicate results, and complete both verbal and written correspondence.

• Research cases referred for peer review and reach out to facilities to arrange physician-to-physician reviews.

• Document the completion of tasks in relevant internal systems.

• Prepare administrative, approval, and clinical denial letters.

• Review finalized denial letters for accuracy, adherence to templates, and appropriate grade level.

• Handle calls from the designated phone queue as required.

• Identify risk situations and escalate them to the supervisor.

• Resolve case issues by collaborating with internal departments, team members, and physicians.

• Consult with internal departments to confirm that cases comply with guidelines.

• Assist in mentoring and training new UM Support Specialists.

• Carry out additional responsibilities assigned by a leader that align with the job's intent.

⛳️ Requirements

• Experience in customer interactions and thorough review of health-related materials.

• Excellent interpersonal skills along with a keen attention to detail.

• Ability to organize work effectively and seek assistance on tasks when necessary.

• Willingness and capability to learn new software applications.

• Strong writing and proofreading capabilities.

• Proficiency in Microsoft Office suite applications.

• Exceptional time management skills.

• Strong analytical abilities.

• Required work experience in the healthcare sector.

• An Associate degree in Business Administration is preferred.

🏝️ Benefits

• Potential eligibility for short-term incentives.

• Comprehensive benefits package.

• Health, life, voluntary, and additional benefits and perks.

• Benefits and perks that support physical, mental, emotional, and financial well-being.

• Tobacco-free workplace.

• Equal Opportunity Employer.