Utilization Management Specialist

Job Opportunity

Pay: $13.00 - $14.00 per hour

Job Type and Schedule

Job Type: Contract

Location: Remote

Schedule and Shift: Monday-Thursday from 8-4:30pm and Friday from 8-12pm

Responsibilities

Initiate Referral Authorizations

• Acquires and maintain a working knowledge of Optum contracted health plans agreements and related insurance products
• Provides administrative and enrollment support for team to meet Company goals
• Gathers information from relevant sources for processing referrals and authorization requests
• Submits authorization & referral requests to healthplan via avenue of insurance requirement. Including but not limited to website, phone, & fax
• Track authorization status inquires for timely response
• Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements related to Utilization Management and authorizations.
• Acts as a liaison between providers, teammates, outside vendors, health plans, community services and patients to support Utilization Management process and requirements
• Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements
• Documents patient information in the electronic health record following standard work guidelines
• Coordinates with Clinical teammates and health plans to identify patients with Utilization Management needs

Provides member services to all patient group

• Answers referral and authorization inquiries from health plans, our clinical areas, patients and outside Optum Physician office/facilities
• Assists in the development and implementation of job specific policy and procedures
• Assists in the collection of information for member and/or provider appeals of denied requests
• Identifies areas for potential improvement of patient satisfaction

About Pride Health

Pride Health is Pride Global's healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.

As a minority-owned business that delivers exceptional service to its clients and candidates by capitalizing on diverse recruiting, account management, and staffing backgrounds, Pride Health's expert team provides tailored and swift sourcing solutions to help connect healthcare talent with their dream jobs. Our personalized approach within the industry shines through as we continue cultivating honest and open relationships with our network of healthcare professionals, creating an unparalleled environment of trust and loyalty.

Equal Employment Opportunity Statement

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.