Utilization Management Specialist
$45.76k - $73.22kBlue Cross and Blue Shield of North Carolina
- # Utilization Management SpecialistApply: Remote Flex - North Carolina: Full time: Posted Yesterday: End Date: September 22, 2026 (4 days left to apply): RQ0019364**Job Description**We’re hiring a Utilization Management Specialist to join the Government Pharmacy UM Operations Team! The Utilization Management Specialist is responsible for the completion of non-clinical reviews and communication to customers to support utilization management reviews and activities. The Utilization Management Specialist may also provide support for administrative functions within the department to support turnaround times.**What You’ll Do*** Conducts nonclinical reviews based on applicable criteria and guidelines on requested services. Communicates decision to provider and/or member, according to department protocols.* Documents outcome of reviews and demonstrates the ability to interpret and analyze the non-clinical information.* Completes verbal or nonverbal outreach to providers or members to obtain the medical information for the review.* Identifies and refers organization determinations that require a clinical review to a nurse or Medical Director.* Conducts reviews of authorizations entered to ensure accuracy to avoid impacting claims payment.* Supports the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards.* Supports the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing.* Serves as a subject matter expert for CM&O around the non-clinical review process.**What You Bring*** High school diploma or GED* 3+ years of experience in related field.**Bonus Points** (Preferred qualifications)* Call center experience is a plus.* Customer service experience in the healthcare/medical space is a plus.**What You’ll Get*** The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community* Work-life balance, flexibility, and the autonomy to do great work* Medical, dental, and vision coverage along with numerous health and wellness programs* Parental leave and support plus adoption and surrogacy assistance* Career development programs and tuition reimbursement for continued education* 401k match including an annual company contribution* Learn more**Where You’ll Work**Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.**Salary Range**At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus\\*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.*\\*Based on annual corporate goal achievement and individual performance.*$45,761.00 - $73,217.00**Skills**Clinical Decision Making, Clinical Decision Support (CDS), Clinical Documentation Review, Clinical Information Systems, Clinical Review, Healthcare Policies, Health Care Regulation, Medical Billing and Coding, Medical Care, Medical Information, Medical Review, Patient Advocacy, Patient Care, Patient Care Coordination, Utilization Management
- J-18808-Ljbffr Blue Cross and Blue Shield of North Carolina
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Utilization Management Specialist in Brooklyn, NY vacancy
$110k
...& Working Hours City/State: Nyack, New York Department: Care Management Work Shift: Day Work Days: MON-FRI Scheduled Hours: 9 AM-5:30... ...outcomes in the expected time frame and with the most efficient utilization of resources. Carries out activities related to utilization...SuggestedDaily paidFull timePart timeFlexible hoursShift work- ## Utility Project Support Specialist (Field Based)Applylocations: Rolling Meadows, Illinois: Kankakee, Illinoistime type: Part timeposted on: Posted... ...duration of **12 months, extendable**.**RESPONSIBILITIES:*** Manage large amount of inbound and outbound phone calls* Track...SuggestedPart timeFixed term contractCasual workRemote workShift work
- ...OVERVIEW ** Under the direct Supervision of the Construction Management Division, to support the Port Authority Office of Safety... ...stakeholders. Demonstrated knowledge using computer safety software utilized for managing and tracking of project hazards, incidents, and...SuggestedFor contractorsWork at officeLocal areaFlexible hoursRotating shiftAfternoon shift
JED Engineering & Land Surveying, P.C.
Jersey City, NJ8 days ago $17 - $18.15 per hour
## Patient Access Associate Specialist - Full TimeApply: Oconto Falls, WI: HSHS - St. Clare... ...of technology-enabled revenue cycle management solutions for health systems, including... ..., and processing physician orders, and utilizing an overlay tool while providing excellent...SuggestedFull timeWork at officeShift workWeekend workDay shift$17 - $18.15 per hour
...Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and... ...information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as...SuggestedWork at officeLocal areaRemote work- ...finance, precision agriculture, nutrient management, energy, feed, grain, and turf.... ...soil testing programs and procedures. Utilizes computer maps to gather data on soil, crops... ...precision farming. Assists crop sales specialists with precision farming meetings, sales...For contractorsWork experience placementInternshipSeasonal workLocal areaNight shift
$62.89k - $75.47k
Job Title Change Management Specialist Pay Rate Min to Mid Range $62,892.00 - $75,468.00 Time Type Full time Summary Duties and Responsibilities... ...Creates and manages measurement systems to track adoption, utilization and proficiency of individual changes Works with BCSO...Full timeShift work- Description The Order Management Specialist: Work Industrial role is responsible for managing the end-to-end order fulfillment process for key... ...problem-solving, and a commitment to exceptional service. Utilize ERP and order management systems to manage customer orders,...Work experience placementWork at office
- ...First Division Consulting provides program management, acquisition, logistics, field service representation, explosive ordnance disposal... ...skills. Strong skills with Microsoft Office software and utilization of information systems. Benefits Medical, dental, vision, life...Work at officeLocal areaRemote work
First Division Consulting Inc
Brooklyn, NY1 day ago - ...City Department of Correction seeks to recruit a Performance Management Specialist to provide support to the Performance Management team with... ...make recommendations to maximize the team's efficiency; - Utilize ePerformance and electronic evaluation systems to capture performance...Work at office
City of New York
East Elmhurst, NY2 days ago $55k
...yourself in a rewarding career for years to come! As the Utilization Review Specialist, you will work in an office based setting located in Trenton... ...of the authorization of treatment via insurance and managed care companies. The Utilization Review Specialist provides...Extra incomeWork at officeOaks Integrated Care
Brooklyn, NY2 days ago- ...Description Reports to: Community Manager Supervises: No one Wage Status: Hourly (Non-Exempt... ...inspiring and customer-focused Leasing Specialist to join our team at The Bainbridge... ...personal computer functions and company-utilized software packages Learning and Development...Hourly payWork at officeLocal area
The Bainbridge Companies
Brooklyn, NY5 days ago - ...Worldwide, LLC is seeking an energetic Leasing Associate in Phoenix to manage leasing, viewings, applications, background checks, and... ...resident satisfaction. You will coordinate marketing efforts and utilize property management software to track activity and leases. Join...Worldwide
Greystar Worldwide, LLC
Brooklyn, NY16 hours ago - ...WOW flavor experiences. We are currently seeking an Order Management Specialist to join our team in Cincinnato, Ohio! In this role you would... ...constrained supply, allocations, and limited-time out of stock. Utilize data for replenishment, inventory management, and joint...Seasonal workWork at officeShift work
$65k - $68.93k
...exempt, and student staff. Primary Responsibilities The Leave Management Specialist manages the Leave Management Program for the Department of... ...position will require working outdoors, in confined spaces, utility rooms, and at rooftop elevations to assess/inspect safety conditions...Contract workWork experience placementWork at officeRemote workAfternoon shift1 day per week- ...Utilization Review Specialist – North Little Rock, AR (72113) Are you an experienced healthcare professional looking for an opportunity to make a difference in patient care management? We’re seeking a Utilization Review Specialist to join our team in North Little Rock,...Work at office
The Wellstone Group
Brooklyn, NY5 days ago $20 per hour
...Per Diem Peer Specialist - NYC About the Organization Concern Housing is a non-profit agency... ...to in ways that fully develop and utilize each person's talent and strengths. Position... ...to work with our Crisis Incident Stress Management (CISM) team to provide support to...Daily paidFull timePart timeInternshipLive inLocal areaFlexible hoursDay shiftAfternoon shiftConcern for Independent Living
Brooklyn, NY2 days ago- DescriptionJ.P. Morgan Wealth Management serves clients across the entire wealth spectrum... ...businesses. Job Description:The Annuity Specialist will provide support to advisors across... ...Advisors, and the Private Bank) on utilizing annuity solutions to meet client investment...
- ...Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations... ...teams. You will apply clinical criteria, coordinate with managed care organizations, complete pre- and post-certifications,...
Memorial Physician Practices
Brooklyn, NY1 day ago - ...being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a vital mission dedicated... ...in this role: Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization...Temporary workPart timeRelief
Memorial Physician Practices
Brooklyn, NY1 day ago $176.72k - $265.08k
...a highly skilled and experienced KDB+ Specialist to be a key contributor to the strategic... ...-performance, low-latency applications utilizing KDB+/Q for our Equities Electronic Trading... ...to platforms enabling efficient data management, sophisticated analytics generation,...Full time- ...the work done in the field. The Safety Specialist works to proactively improve safety performance... ...works collaboratively with field management and leadership to ensure safety polices... ...and control measures are in place, utilized, and effective; address risks and safety...Work experience placementWork at officeLocal area
$79.2k - $110.9k
...Wealth Enhancement is an independent wealth management firm with an endless passion for... ...exciting opportunity for a **Facilities Specialist**! This position plans and manages the... ...Support and improve branch office space utilization efficiencyEstablish processes and communications...Full timeContract workTemporary workWork at officeRemote workRelocationFlexible hours- ...- from permanent and extended workforce management to services procurement, consulting, direct... ...network. Job Description The Program Specialist I is responsible for building and... ...in appropriate database (VMS, AGS360) Utilize reports to manage open requirements to advise...Permanent employmentContract workTemporary work
$18.15 - $19.9 per hour
## Specialist, Financial CounselingApplylocations: Paducah, KYtime type: Full timeposted on... ...provider of technology-enabled revenue cycle management solutions for health systems, including... ...in Inpatient Collections will utilize face to face communication with patients...Local areaRemote workShift workNight shiftWeekend work$23.2 - $31 per hour
...job opportunities at Howard Head Sports Medicine. Intake Specialist New Schedule Schedule Full-time year-round Shift Rotating... ...The Intake Specialist also works closely with the hospital’s Utilization Management/Utilization Review, Admissions, Insurance Verification, and...Hourly payFull timeTemporary workImmediate startRotating shift- ...seeking a Temporary Performance Nutrition Specialist to assist with the NFL Combine program at... ...daily athlete protocols. Education, Athlete Management & Sports Science Deliver personalized 1:1 nutrition recommendations utilizing Exos methodology to drive long‑term...Temporary workRemote work
$38.5k
Utilization Review Specialist Agency 452 MENTAL HEALTH AND SUBSTANCE ABUSE SERV. Supervisory Organization GMH - Utilization Review Job Posting End... ...(UR) Specialist supports the facility's utilization management processes. Responsibilities include preparing documentation...Hourly payFull timePart timeWork at officeMonday to FridayFlexible hoursWeekend work$96k - $118k
...That's Sharing Expertise. QAO Chemistry Specialist II Company: B. Braun US Pharmaceutical Manufacturing... ..., a leader in infusion therapy and pain management, develops, manufactures, and markets... ..., compliance, and data integrity. Utilize Empower, LabWare LIMS, SAP, and...Work at officeWorldwideRelocationShift work- POSITION: Enrollment Specialist LOCATION: North Texas (preferred) REPORTS TO: Senior Director... ...Academies is a non-profit charter management organization (CMO) that operates classical... ...degree of accuracy and attention to detail. Utilize advanced Microsoft Excel functions,...Full timeWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Management Specialist. Be the first to apply!
Related searches
- fmla specialist Brooklyn, NY
- wire specialist Brooklyn, NY
- emr specialist Brooklyn, NY
- letter of credit specialist Brooklyn, NY
- candidate experience specialist Brooklyn, NY
- sterilization specialist Brooklyn, NY
- gaming specialist Brooklyn, NY
- channel specialist Brooklyn, NY
- information technology specialist Brooklyn, NY
- leasing specialist Brooklyn, NY