Inpatient UM Specialist

Job Summary

Supporting utilization management and prior authorization operations, the experienced Inpatient UM Specialist will work remotely on a contract basis, reviewing and processing authorization requests for various healthcare services while ensuring compliance and exceptional service delivery.

Key responsibilities

• Review, prioritize, and process incoming authorization requests for inpatient, outpatient, and ancillary services
• Serve as the primary point of contact for providers and members, addressing inquiries related to authorization requirements and service coverage
• Document interactions and authorization activities accurately within designated healthcare systems and collaborate with clinical teams to resolve escalated issues

Required qualifications

• Associate degree in Healthcare, Social Work, Business, or a related field; equivalent combination of education and experience will be considered
• Three or more years of experience in healthcare administration, utilization management support, or prior authorization
• Experience with healthcare management platforms or authorization systems preferred
• Knowledge of health plan operations, utilization management processes, and member benefits
• Proficiency with Microsoft Office applications and ability to work independently in a fully remote setting