Utilization Mgmt Specialist
Core
Receiving inquiries, determining if medical or pharmacy review decisions are required, coordinating authorizations, and managing documentation for a health insurance department.
Role type
Utilization Management Specialist (Administrative)
Builds
Medical and pharmacy authorization workflows for health insurance members and providers
Domain
Health Insurance / Utilization Management
Deliverable
client delivery
Required skills
Medical or pharmacy documentation verification, authorization coordination, regulatory compliance (URAC, state/federal), multi-tasking, internal/external communication
Preferred skills
Bachelor's Degree, Medical Office experience
Technologies
Medical Management System
Responsibilities
Maintain and verify medical or pharmacy documentation, coordinate authorization for review, communicate with members, providers, and internal departments, ensure compliance with regulations and URAC guidelines, meet quality and production standards
Seniority
Entry-level to Mid-level, hands-on IC