Senior Utilization Management Specialist (Remote)

Providence Health Plan Group; Irvine, Northern (CA, KY); Hybrid; USD 71,635,000 - 102,631,000; Full time

Job summary

Providence Jobs in California seeks a Senior Utilization Management Assistant for a fully remote, full-time role with day shifts. You will assist the Care Management team, coordinating patient care and handling administrative tasks related to utilization review and admissions.

Strong hospital/healthcare experience and knowledge of insurance/billing are essential. Join a mission-driven provider network with comprehensive benefits and a focus on patient-centered, whole-person care in a

Qualifications

• 5 years Hospital, clinical setting or healthcare related field.
• 3 years Demonstrated outstanding customer service experience.
• 3 years Clerical and computer experience.
• 3 years Knowledge of insurance billing and managed care.
• Coursework/Training Some college level course work Or equivalent educ/experience
• High School Diploma or GED equivalent or some college level course work preferred particularly Medical Terminology or Medical Assistance coursework.
• Coursework/Training Medical Terminology or Medical Assistant Or equivalent educ/experience
• Coursework/Training CHAA Or equivalent educ/experience
• Within 6 months (180 days) of hire: CHAA (If in California)
• 3 years EPIC Case Management and ADT Patient Access.

Responsibilities

• Under supervision of Regional Director of Care Management, provides support to the Care Management team.
• Coordinates care as part of the healthcare team.
• Performs complex tasks related to assessment and management of patients.
• Supports wage range communications and broader team activities.

Skills

Hospital/Healthcare experience

Customer service

Clerical/Computer skills

Insurance billing & managed care

Education

Some college/educ/experience

HS diploma or GED

Medical terminology/MA coursework

CHAA or equivalent education/experience

CHAA within CA hire window

EPIC Case Management exposure

Tools

EPIC Case Management

ADT Patient Access

Job description

Providence Jobs in California seeks a Senior Utilization Management Assistant for a fully remote, full-time role with day shifts. You will assist the Care Management team, coordinating patient care and handling administrative tasks related to utilization review and admissions.

Strong hospital/healthcare experience and knowledge of insurance/billing are essential. Join a mission-driven provider network with comprehensive benefits and a focus on patient-centered, whole-person care in a