Utilization Management Specialist

Job Summary

Working remotely or in a hybrid capacity, the full-time Utilization Management Specialist will manage inquiries related to medical and pharmacy reviews, coordinate authorizations, and ensure accurate documentation and communication with internal and external stakeholders.

Key responsibilities:

• Maintain, receive, and verify medical or pharmacy documentation
• Determine the necessity of medical or pharmacy review decisions and coordinate authorizations
• Communicate regularly with members, providers, and internal departments to ensure compliance and quality standards

Required qualifications:

• Associate's Degree or equivalent combination of education and experience
• 1 year of experience in a healthcare-related field
• Ability to multi-task effectively