Utilization Management Specialists - Everett, United States - Medix

Medix Everett, United States

1 day ago

Description

This is a REMOTE opportunity for individuals with experience in Utilization Management, offering benefits and weekly pay.

The position of Utilization Management Specialist involves implementing, maintaining, and executing procedures and processes for Optum's referral and authorization process. This role handles inquiries from patients, staff, and physicians regarding referral authorization questions, including researching medical history and diagnostic tests to aid in the review, processing, and coordination of referrals.

Job Title: Utilization Management Specialist

Company: Optum

Responsibilities:

Initiating Referral Authorizations
Acquiring and maintaining a working knowledge of Optum contracted health plans agreements and related insurance products
Providing administrative and enrollment support for the team to achieve Company goals
Gathering information from relevant sources for processing referrals and authorization requests
Submitting authorization & referral requests to health plans based on insurance requirements
Tracking authorization status inquiries for timely responses
Maintaining a strong understanding of contracted health plans' requirements related to Utilization Management and authorizations, educating physicians, clinical teammates, patients, and families
Acting as a liaison between providers, teammates, vendors, health plans, community services, and patients to support Utilization Management processes and requirements
Reviewing benefit language and medical records to assist in the completion of requested services as per health plan requirements
Documenting patient information in the electronic health record following standard work guidelines
Coordinating with Clinical teammates and health plans to identify patients with Utilization Management needs
Providing member services to all patient groups
Answering referral and authorization inquiries from health plans, clinical areas, patients, and outside Optum Physician office/facilities
Assisting in the development and implementation of job-specific policies and procedures
Collecting information for member and/or provider appeals of denied requests
Identifying areas for potential improvement in patient satisfaction

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