Remote Authorization & Utilization Specialist

Manpower, Inc.; Durham (NC); Remote; USD 37,000 - 41,000; Part time

Benefits offered by this job

Fully remote work

Structured training program

Exposure to leading healthcare org

Job summary

Manpower, Inc. is seeking a Utilization Management Specialist for a fully remote contract role in healthcare. You will review non-clinical authorization requests, coordinate with providers and members, and support CMS requirements in a high-volume environment.

The position offers a $27-$30/hour pay rate, Monday–Friday 8:00 AM–5:00 PM, and structured onboarding. Candidates must have 3+ years in utilization management, healthcare insurance, or pharmacy operations and eligibility to work in the US.

Qualifications

• 3+ years of experience in utilization management, healthcare insurance, retail pharmacy, or a related healthcare field.
• Experience in a high-volume, fast-paced environment.
• Medicare experience preferred.
• Retail Pharmacy Technician experience preferred.
• Must be eligible and provide proof of eligibility to work in the US.

Responsibilities

• Conduct non-clinical reviews of authorization requests using established criteria and guidelines.
• Communicate review outcomes to providers and members according to department protocols.
• Document review decisions accurately and analyze non-clinical information to support determinations.
• Reach out to providers and members to obtain information needed to complete reviews.
• Refer cases requiring clinical evaluation to nurses or Medical Directors.
• Review authorizations for accuracy to help prevent claims payment issues.
• Support care management activities by completing member and provider outreach to meet CMS requirements.
• Process and route incoming faxed documentation to appropriate teams for review and action.
• Serve as a subject matter expert on non-clinical utilization management processes.
• Handle periodic inbound calls from Tier 1 support teams and assist with prior authorization activities.

Skills

Communication skills

Attention to detail

Time management

Multiple systems

Education

High school diploma or GED

Job description

Manpower, Inc. is seeking a Utilization Management Specialist for a fully remote contract role in healthcare. You will review non-clinical authorization requests, coordinate with providers and members, and support CMS requirements in a high-volume environment.

The position offers a $27-$30/hour pay rate, Monday–Friday 8:00 AM–5:00 PM, and structured onboarding. Candidates must have 3+ years in utilization management, healthcare insurance, or pharmacy operations and eligibility to work in the US.