Advanced Utilization Management Specialist

Job Summary

Providing advanced operational expertise, the full-time Advanced Utilization Management Operations Specialist will support complex case resolution, oversee utilization management inventory, and drive issues through resolution while working remotely.

Key responsibilities

• Serve as an escalation resource for complex authorization cases and investigate operational issues
• Support daily management of utilization management inventory, identifying and resolving discrepancies
• Conduct root cause analysis of operational errors and recommend corrective actions in collaboration with cross-functional teams

Required qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration or related field preferred
• Minimum of 5 years of experience in utilization management, prior authorization, or healthcare operations preferred
• Strong knowledge of utilization management workflows and DMEPOS experience strongly preferred
• Experience with Medicare, Medicaid, and Commercial health plan requirements preferred
• Demonstrated ability to analyze complex operational issues and navigate multiple systems for case resolution