Utilization Management Specialist

Job Summary

Responsible for managing non-clinical reviews, the full-time remote Utilization Management Specialist will write denial letters for medical necessity, participate in staff training, and assist in resolving claims discrepancies.

Key responsibilities

• Writes and edits all denial letters for medical necessity
• Participates in training programs for new staff and assists in training existing employees on new procedures
• Conducts staff audits and manages monitoring tools to ensure quality of work by coordinators

Required qualifications

• Bachelor's Degree or equivalent relevant work experience
• Minimum of 3+ years of experience in a managed care or health industry environment
• Proficiency in performing data entry tasks in multiple applications
• Ability to manage multiple priorities and operate within a sensitive framework
• Strong organizational and conflict resolution skills