Utilization Review Payer Specialist | Case Management | Days

Utilization Review Payer Specialist | Case Management | DaysUnder the direction of the UR RN Manager, the Payer Specialist provides essential administrative and operational support to the Utilization Management (UM) team. This role helps ensure administrative utilization review processes run efficiently and accurately by managing incoming UM correspondence, tracking and entering payer authorizations, clinical review requests, and addresses denials, prepares and organizes clinical review packets, and facilitates timely communication between internal departments, external payers, and other stakeholders. The specialist prioritizes and manages multiple demands in a fast-paced environment while supporting UR nurses, physician advisors, and UM staff to promote appropriate utilization of healthcare resources, regulatory compliance, and timely reimbursement.Responsibilities:Administrative & Clerical Support: Provides daily clerical and administrative support to the Utilization Management (UM) team.Data Management & Documentation: Accurately enter, update, and maintain patient data, payer responses, authorizations, and denial details in Epic and other UM systems.Utilization Management Workflow Coordination: Monitor UM work queues and tasks to ensure reviews, submissions, and follow-ups are completed within required timeframes.Authorization, Denials & Payer Communication: Submit clinical documentation and authorization requests to payers through secure fax, portals, or phone in accordance with departmental workflows.Quality, Compliance & Performance Improvement: Ensure documentation, submissions, and data entry activities are completed accurately and within established regulatory, payer, and organizational requirements.Collaboration & Customer Service: Establish effective working relationships with cross-functional teams, stakeholders, and client groups, cultivating strong professional rapport and collaboration.Minimum Requirements:2+ years of experienceHigh School Equivalency DiplomaFingerprint Clearance CardJoin us at Yuma Regional Medical Center dba Onvida Health A career at Onvida Health is more than just a job. It's a place to have a long and rewarding career, making a difference in the lives of those in our shared community. When you join our team, you become an integral part of a thriving community committed to improving the health and well-being of everyone in southwestern Arizona. At Onvida Health, we believe in progress with purpose. Our commitment to innovation is matched by our dedication to kindness and integrity. We take our values seriously because we know they lead to better outcomes for our patients and a better experience for all of us. We're looking for people who approach each day with a sense of possibility, a drive to make things better, and a commitment to kindness. If that sounds like you, you're our kind of people. If you're looking for a career where innovation meets compassion, where you can grow and contribute to building a healthier tomorrow, Onvida Health is the place for you.Life in Yuma, Arizona Yuma, recognized by Guinness World Records as the Sunniest City on Earth, offers more than just sunshine. It's a place where the great outdoors meets a welcoming, tight-knit community. Hike scenic trails, explore the Colorado River, or immerse yourself in local cultural festivals – all while embracing the beauty of this desert oasis. With easy access to larger cities and popular destinations, Yuma makes it easy to balance a fulfilling career with time for personal adventures and relaxation.