Remote Utilization Management Specialist I

Excellus BCBS; City of Rochester (NY); Hybrid; USD 28.000 - 37.000; Vollzeit

Zusammenfassung

Excellus BCBS is seeking a motivated UM Services Support role to assist with utilization management workflows, handling calls, and creating authorizations for inpatient and outpatient services. You will work with providers and members, ensuring timely, accurate processing aligned with regulatory requirements.

Level I–III responsibilities include triage, training, and collaboration with Claims and Care Management to ensure end-to-end accuracy and efficiency in authorizations, notifications, and

Qualifikationen

• High School Diploma or GED required with strong written and verbal skills.
• Experience with desktop computing and MS Office preferred.
• Call center experience is a plus but not required.

Aufgaben

• Provide administrative support and customer service for UM workflows.
• Serve as primary contact for providers requesting authorizations.
• Handle inbound/outbound calls and triage UM-related inquiries.
• Assist with regulatory notifications and documentation timelines.
• Support cross-department collaboration to ensure end-to-end authorization processes.

Kenntnisse

Analytical skills

Communication skills

Organizational skills

Independence / self-motivation

Call center experience

MS Office proficiency

Ausbildung

High School Diploma or GED

Tools

Microsoft Office

Jobbeschreibung

Excellus BCBS is seeking a motivated UM Services Support role to assist with utilization management workflows, handling calls, and creating authorizations for inpatient and outpatient services. You will work with providers and members, ensuring timely, accurate processing aligned with regulatory requirements.

Level I–III responsibilities include triage, training, and collaboration with Claims and Care Management to ensure end-to-end accuracy and efficiency in authorizations, notifications, and