What are the responsibilities and job description for the Utilization Management Specialist position at Robert Half?
Job Description
Job Description
We are offering a long-term employment opportunity for a Utilization Management Specialist in Durham, North Carolina, United States. This role primarily involves non-clinical reviews based on relevant criteria and guidelines, along with effective communication and documentation of review outcomes.
Responsibilities :
- Conduct non-clinical reviews based on applicable standards and guidelines
- Ensure accurate communication of review outcomes to providers and / or members in accordance with department protocols
- Document review outcomes accurately and demonstrate the ability to interpret and analyze non-clinical information
- Perform outreach to providers or members to secure medical information necessary for the review
- Identify and forward organization determinations that necessitate a clinical review to a nurse or Medical Director
- Review entered authorizations for accuracy to prevent impact on claims payment
- Support the care management department through outreaches to members or providers to meet CMS requirements for information solicitation or notification standards
- Assist the administrative support team in retrieving and attaching facsimiles to ensure customer requests are forwarded to the appropriate area for processing
- High school diploma or GED
- 3 years of experience in related field.
