System Utilization Management Specialist: Payer Liaison

Alameda Health System; Oakland (CA); On-site; USD 47,000 - 79,000; Full time

Job summary

Alameda Health System in Oakland, California, seeks a System Utilization Management Specialist to support the UM team across all campuses. You will handle payer communications, authorizations, and data entry in EPIC, ensuring timely processing of inpatient cases.

The role emphasizes clinical and administrative duties within Utilization Management, with potential system-wide coverage and onboarding involvement.

Qualifications

• Associate degree or 2–3 years of health education/related experience in inpatient, skilled nursing, home health, health plan or related setting.
• Minimum three (3) years in a health care setting with interdisciplinary team/patients/families.
• Hospital or health plan experience preferred.

Responsibilities

• Serve as payer liaison and primary contact for insurance inquiries, communicating with payers and documenting in EPIC.
• Manage inpatient authorization processes: obtain initial and concurrent authorizations and track status.
• Maintain accurate records of fax communications and ensure clinical documents reach payers.

Skills

Payer liaison

Data entry

Multitasking

Communication

Interdisciplinary teamwork

Education

Associate degree or equivalent experience

3 years health care experience

Tools

EPIC

Optum Portal

Job description

Alameda Health System in Oakland, California, seeks a System Utilization Management Specialist to support the UM team across all campuses. You will handle payer communications, authorizations, and data entry in EPIC, ensuring timely processing of inpatient cases.

The role emphasizes clinical and administrative duties within Utilization Management, with potential system-wide coverage and onboarding involvement.