Utilization Management Services Specialist I (Remote)

Excellus Health Plan Inc.; City of Rochester (NY); Remote; USD 28,000 - 37,000; Full time

Job summary

Excellus Health Plan Inc. is seeking a level I–III Utilization Management Administrative Support role to enhance UM workflows. You will handle inbound/outbound calls, create authorizations via phone, Care Advance Provider Tool, and fax for inpatient/outpatient procedures, behavioral health, and DME.

You will support providers and members, triage UM services, and back up team leads while interfacing with Claims, Customer Service and care management units to ensure accurate end-to-end processes.

Qualifications

• Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.
• Call center experience preferred.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work within a team.
• Self-motivated and able to work independently.

Responsibilities

• Handle inbound and outbound calls to members and providers with excellent customer service.
• Provide information regarding services in a call center environment.
• Assist with authorizations and regulatory notifications.
• Assist with triage and coordination with other departments for UM services.
• Support scheduling Fair Hearings and coordinating Grievance/Appeals as needed.
• Back up Team Leads and assist with offline projects.

Skills

Customer service

Call center

Analytical skills

Communication skills

Organizational skills

Independent work

Education

High School Diploma or GED

Tools

FACETS

PEGA

Care Advance Tool

Microsoft Office

Job description

Excellus Health Plan Inc. is seeking a level I–III Utilization Management Administrative Support role to enhance UM workflows. You will handle inbound/outbound calls, create authorizations via phone, Care Advance Provider Tool, and fax for inpatient/outpatient procedures, behavioral health, and DME.

You will support providers and members, triage UM services, and back up team leads while interfacing with Claims, Customer Service and care management units to ensure accurate end-to-end processes.