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Form of workJob Description
Large managed care company is looking Utilization Management Specialists with great customer service skills to be answers referral and authorization inquiries from health plans, clinical areas, patients and outside office/facilities.
Work Location: 1800 41St Street, S-500, Everett, WA 98203
Pay: $22.00
Contract Dates: ASAP to 7/31/2024
Hours: Monday – Friday, 8-5:30 (40 hrs/wk)
JOB DESCRIPITON
The Utilization Management Specialist implements, maintains and executes procedures and processes by which Optum performs 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.
RESPONSIBILITIES
- Initiate Referral Authorizations
- Acquires and maintain a working knowledge of contracted health plans agreements and related insurance products
- Gathers information from relevant sources for processing referrals and authorization requests
- Submits authorization & referral requests to health plan via avenue of insurance requirement.
- Track authorization status inquires for timely response
- 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
QUALIFICATIONS
- Highschool/GED or equivalent
- 2+ years of experience working in electronic health systems
- Working knowledge and prior UM experience
- Previous industry experience is required
- Proficiency in MS Office (Word, Excel, and Outlook
- Excellent written and verbal communication skills
