Utilization Management Specialist

Job Summary

Supporting the physician advisor process, the remote Utilization Management Support Specialist I will assist in scheduling peer-to-peer reviews, documenting tasks, and preparing administrative correspondence while ensuring accuracy and compliance.

Key responsibilities

• Research and schedule peer reviews, documenting task completion and preparing clinical denial letters
• Identify risk situations and escalate issues to the supervisor as necessary
• Troubleshoot case issues by coordinating with internal departments and assist in mentoring new UM Support Specialists

Required qualifications

• Experience in healthcare and customer interactions
• Associate degree in Business Administration or related field preferred
• Proficiency in Microsoft Office suite applications
• Strong writing and proofreading skills for document accuracy
• Ability to organize work and learn new software applications