Utilization Management Specialist I (Remote)

Univera Healthcare; City of Rochester (NY); Remote; USD 28,000 - 37,000; Full time

Job summary

Univera Healthcare seeks a detail-oriented team member to support Utilization Management workflows through administrative tasks and customer service. You will handle inbound and outbound calls, authorizations via phone and tools, and coordinate with providers for inpatient and outpatient services.

Level I–III responsibilities include assisting with projects, coaching, and cross-department collaboration to ensure end-to-end authorization processes meet regulatory guidelines.

Qualifications

• High School Diploma or GED required; multiple levels based on knowledge and scope of responsibilities.
• Call center experience preferred but not required; must have strong communication and problem-solving abilities.
• Proven ability to work in teams, manage multiple priorities, and handle confidential information.

Responsibilities

• Provide administrative support and customer service for UM workflows.
• Serve as primary contact for providers on authorization requests and regulatory communications.
• Collaborate with Claims, Customer Service, and Care Management to ensure end-to-end authorization and notifications processes.
• Assist with training and coaching UM Services Reps and support staff.

Skills

Analytical thinking

Communication skills

MS Office

Call center experience

Team collaboration

Self-motivation

Organizational skills

Education

High School Diploma or GED

Tools

FACETS

PEGA

Care Advance Provider Tool

Job description

Univera Healthcare seeks a detail-oriented team member to support Utilization Management workflows through administrative tasks and customer service. You will handle inbound and outbound calls, authorizations via phone and tools, and coordinate with providers for inpatient and outpatient services.

Level I–III responsibilities include assisting with projects, coaching, and cross-department collaboration to ensure end-to-end authorization processes meet regulatory guidelines.