Intake/Utilization Mgmt Specialist Full time Days
Core
Point-of-entry specialist for Home Infusion Pharmacy handling front-end utilization management, prior authorizations, and eligibility verification.
Role type
Intake/Utilization Management Specialist
Builds
Safe and efficient intake processes for home infusion pharmacy services
Domain
Healthcare / Home Infusion Pharmacy
Deliverable
Dashboards & analysis
Required skills
Utilization management, Prior authorization, Eligibility verification, Benefits investigation, Insurance regulations knowledge, Electronic portal navigation, Patient onboarding
Preferred skills
Call center experience, Analytical problem solving, High-level investigation
Technologies
Allscripts/Careport, CPR+, EPIC, Microsoft applications
Responsibilities
Scrutinize prospective referrals for acceptance or denial, Conduct eligibility verification and benefits investigation, Execute prior authorizations and assist with appeals, Coordinate with case managers, social workers, and physicians, Update patient profiles and communication notes, Participate in quality improvement initiatives
Seniority
Entry-level to Mid-level, hands-on IC