Utilization Management Specialist I: Authorization & Care Support

Lifetime Workforce Solutions, LLC; City of Rochester (NY); On-site; USD 28,000 - 37,000; Full time

Job summary

Excellus BCBS is seeking an inpatient/outpatient UM Services Support role to handle incoming/outgoing calls, create authorizations, and liaise with providers and members. The position emphasizes accuracy, privacy, and adherence to regulatory timeframes as part of a growing UM team.

Responsibilities span triage, provider contact for authorizations, and collaboration across departments to ensure end-to-end processes, with a focus on customer-centered service and adherence to company values.

Qualifications

• Level I requires a High School Diploma or GED and basic computer skills with Microsoft Office.
• Call center experience is preferred but not required.
• Strong analytical and problem-solving skills are essential.
• Excellent written and verbal communication and ability to work in a team.
• Well-developed organizational skills to manage multiple projects and priorities.

Responsibilities

• Facilitates inbound and outbound calls to customers (members and providers) delivering customer-centered service.
• Performs triage for UM Services and serves as primary contact for authorization requests.
• Contacts members/providers regarding regulatory requirements (DOH, NCQA).
• Ensures timely and accurate responses to research inquiries and processes fax requests.
• Collaborates with Claims, Customer Service, and Care Management to ensure end-to-end authorization processes.

Skills

Call center experience

Analytical and problem-solving

Written and verbal communication

Organizational skills

Teamwork

Self-motivated and independent work

Microsoft Office knowledge

Education

High School Diploma or GED

Tools

FACETS

PEGA

Microsoft Office

Job description

Excellus BCBS is seeking an inpatient/outpatient UM Services Support role to handle incoming/outgoing calls, create authorizations, and liaise with providers and members. The position emphasizes accuracy, privacy, and adherence to regulatory timeframes as part of a growing UM team.

Responsibilities span triage, provider contact for authorizations, and collaboration across departments to ensure end-to-end processes, with a focus on customer-centered service and adherence to company values.