Healthcare Resolution Specialist (Non-Clinical)

Universal Health Services, Inc.; Reno (NV); On-site; USD 48,000 - 64,000; Full time

Benefits offered by this job

Loan Forgiveness

Competitive PTO

Excellent health plans

401(k) with company match

Student loan refinancing (SoFi)

Career development opportunities

Job summary

Prominence Health, part of Universal Health Services, seeks a Medical Management Resolution Specialist to oversee daily operations, ensure complete information for inquiries, and meet deadlines per policy. The role supports initial intake screening and coordination with licensed professionals.

You will work within a value-based care environment, applying CMS guidelines and health plan knowledge to improve workflow and member outcomes.

Qualifications

• Associates degree or higher or equivalent work experience preferred.
• Detailed knowledge of CPT/HCPCS, ICD-9/10 coding, and medical terminology preferred.
• Previous experience in Utilization/Medical Management within a Health Plan environment is preferred.
• Must be extremely organized, detail oriented, meet deadlines, and work well under pressure.
• Language skills: ability to communicate effectively in English, both verbally and in writing.
• Familiarity with CMS guidelines.

Responsibilities

• Monitor daily operations within the Medical Management Department.
• Ensure complete and accurate information on inquiries and deadlines met per policy.
• Perform intake screening and collection of non-clinical data.
• Coordinate with licensed health professionals during initial screening.
• Adhere to state and federal requirements related to Utilization Management.

Skills

English communication

Organizational skills

Attention to detail

Multitasking

Problem solving

Critical thinking

MS Office proficiency

Team player

Independent judgment

Empathetic listener

Education

Associates degree or higher

Tools

MS Office (Excel, Word, Access, PowerPoint, Outlook)

Job description

Prominence Health, part of Universal Health Services, seeks a Medical Management Resolution Specialist to oversee daily operations, ensure complete information for inquiries, and meet deadlines per policy. The role supports initial intake screening and coordination with licensed professionals.

You will work within a value-based care environment, applying CMS guidelines and health plan knowledge to improve workflow and member outcomes.