What are the responsibilities and job description for the Utilization Review Specialist position at Umpqua Health Management LLC?
REMOTE ROLE: SET SCHEDULE:
MONDAY-FRIDAY 8AM-5PM PST, MUST BE ABLE TO WORK THIS SCHEDULE.
The Role:
As a Utilization Review Specialist, you will be responsible for ensuring that healthcare services are medically necessary, efficiently provided, and appropriately utilized. This role involves reviewing patient medical records, assessing and evaluating requests for medical services, treatments, or procedures to determine their appropriateness, and ensuring compliance with regulatory and payer requirements. You will also play a key role in the intake, processing, and finalization of all prior authorizations received by the Medical Management team, coordinating with healthcare providers to facilitate accurate and timely approval of services. Your work will directly support the goal of delivering high-quality, cost-effective care.
Your Impact:
Performs data entry of authorization information (per policy/procedure) into web-based system as received through telephone calls, voice mail messages and emails.
Gathers and organizes clinical information for review.
Communicates authorization request status to the providers as per policy and procedure.
Writes coverage determination letters.
Works with computer/electronic medical records daily.
Perform other duties as assigned by management to help drive our Vision, fulfill our Mission, and abide by our Organization’s Values.
Your Credentials:
High School Diploma or equivalent work experience.
Demonstrate a proficiency in computer skills, Windows, Word, Excel, Outlook, clinical platforms, internet searches
Knowledge of ICD 10 codes, CPT codes and medical terminology a bonus.
Excellent organizational and communication skills.
Ability to be flexible and work in a fast-paced office environment.
Ability to prioritize a high volume of work.
Medical office or hospital experience preferred but not required
Excellent analytical and critical thinking skills.
Strong communication and interpersonal skills, with the ability to work effectively with healthcare providers, patients, and insurance companies.
Proficient in using electronic medical records (EMR) systems and utilization management software.
Rate: Varies on experience, education, location $19-$23/hr
Benefits:
Medical, Dental, & Vision Plans
Health Spending Accounts & Flexible Spending Accounts
PTO paid holidays
401K
Paid Family Leave
Employee Assistance Programs
Disability and Insurance: Short Long Term
Opportunities for advancement
Salary : $19 - $23
