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Utilization Management Specialists
- Posted: April 22, 2024
- Salary:US$17 - US$21 per hour
- Location:Everett
- Job type: Contract
- Discipline:Revenue Cycle
- Reference:225668_1713822670
- Work Location:Remote
Job description
*Position is fully remote but must reside near Everett, WA*
The Utilization Management Specialist implements, maintains and executes procedures and processes by performing its referral and authorization process. This position responds to inquiries from patients, staff and physicians pertaining to referral authorization questions. The position also researches medical history and diagnostic tests when requested, to assist in review, processing, and coordination of prospective, concurrent and retrospective referrals.
Overview Of Responsiblities:
- Initiate Referral Authorizations
- Acquires and maintain a working knowledge of Optum contracted health plans agreements and related insurance products
- Provides administrative and enrollment support for team to meet Company goals
- Gathers information from relevant sources for processing referrals and authorization requests
- Submits authorization & referral requests to healthplan via avenue of insurance requirement.
- Track authorization status inquires for timely response
- Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements related to Utilization Management and authorizations.
- Acts as a liaison between providers, teammates, outside vendors, health plans, community services and patients to support Utilization Management process and requirements
- Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements
- Documents patient information in the electronic health record following standard work guidelines
- Coordinates with Clinical teammates and health plans to identify patients with Utilization Management needs
- Provides member services to all patient group
- Answers referral and authorization inquiries from health plans, our clinical areas, patients and outside Optum Physician office/facilities
- Assists in the development and implementation of job specific policy and procedures
- Assists in the collection of information for member and/or provider appeals of denied requests
- Identifies areas for potential improvement of patient satisfaction
Must Have Skills/Qualifications
- Referrals / Pre-Auth experience
- Logging onto Payer Portals (Availity, OWCP, SAW, etc.)
- Benefit eligibility check experience
- Tech Savvy
- Excellent Communication Skills
Schedule/Shift: Monday-Friday from 8:30-5pm - Remote