Remote Utilization Management Specialist

Motion Recruitment; Durham (NC); Remote; USD 65,000 - 80,000; Full time

Job summary

Motion Recruitment is seeking a Utilization Management Specialist for a remote contract role serving health insurance clients. The candidate will perform non-clinical reviews, communicate determinations to providers and members, and document outcomes while interpreting non-clinical information.

Eligible applicants must pass drug and background checks. Reqs include 3–5 years in related field with UM experience, high-volume workflow, and strong attention to detail.

Qualifications

• 3–5 years of experience in a related field.
• UM experience and high-volume review skills.
• High school diploma or GED required.

Responsibilities

• Conducts non clinical 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 non verbal 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 CMS requirements.
• 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.

Skills

UM experience

Attention to detail

High volume environment

Education

High school diploma or GED

Job description

Motion Recruitment is seeking a Utilization Management Specialist for a remote contract role serving health insurance clients. The candidate will perform non-clinical reviews, communicate determinations to providers and members, and document outcomes while interpreting non-clinical information.

Eligible applicants must pass drug and background checks. Reqs include 3–5 years in related field with UM experience, high-volume workflow, and strong attention to detail.