Remote Utilization Management Specialist

Us Tech Solutions; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

US Tech Solutions is seeking a Utilization Management Specialist to support non-clinical review activities within the UM department. You will coordinate coverage determinations, prepare denial letters, and monitor daily processes in collaboration with healthcare providers, hospitals, and internal teams.

The role requires a Bachelor's degree or equivalent, and a minimum of 3 years of experience in a managed care or healthcare setting.

Qualifications

• Bachelor's degree or equivalent relevant work experience.
• Minimum of 3 years of experience in a managed care or healthcare industry environment.

Responsibilities

• Write and edit medical necessity denial letters.
• Participate in structured training programs for new staff.
• Assist in training existing employees on new procedures, processes, and systems.
• Conduct staff audits and support monitoring activities to ensure quality and accuracy of coordinators' work.
• Coordinate coverage determinations for designated products and accounts.
• Assist partner departments in resolving claims discrepancies and misdirected activities.
• Investigate root causes of operational issues and recommend appropriate solutions.
• Support departmental administrative activities, information requests, and follow-ups.
• Participate in projects and special assignments to meet deadlines and compliance requirements.
• Represent the department on committees as requested.
• Communicate regularly with network providers, hospital contacts, provider office staff, and internal departments.
• Perform other duties and responsibilities as assigned.

Skills

Communication

Data entry

Multitasking

Attention to detail

Independent worker

Interpersonal skills

Team collaboration

Education

Bachelor's degree or equivalent

Job description

US Tech Solutions is seeking a Utilization Management Specialist to support non-clinical review activities within the UM department. You will coordinate coverage determinations, prepare denial letters, and monitor daily processes in collaboration with healthcare providers, hospitals, and internal teams.

The role requires a Bachelor's degree or equivalent, and a minimum of 3 years of experience in a managed care or healthcare setting.