What are the responsibilities and job description for the Utilization Management Specialist position at Pyramid Consulting, Inc?
Job ID: 25-64059
Pay Range: $24 - $25/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Conducts non clinical reviews based on applicable criteria and guidelines on requested services. Communicates decision to provider and/or member, according to department protocols.
- Documents outcome of reviews and demonstrates the ability to interpret and analyze the non-clinical information.
- Completes verbal or non verbal outreach to providers or members to obtain the medical information for the review.
- Identifies and refers organization determinations that require a clinical review to a nurse or Medical Director.
- Conducts reviews of authorizations entered to ensure accuracy to avoid impacting claims payment.
- Supports the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards.
- Supports the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing.
- Serves as a subject matter expert for CM&O around the non-clinical review process.
- Hiring Requirements
Key Requirements and Technology Experience:
- Key skills; Pharmacy, Pharmacy Tech, Pharmacy Technician
- High school diploma or GED
- 3 years of experience in related field.
Our client is a leading Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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Salary : $24 - $25
