Utilization Management Support Specialist I - Remote Tues-Sat

Santa Barbara Cottage Hospital; United States; Remote; USD 37,000 - 57,000; Full time

Job summary

Santa Barbara Cottage Hospital is seeking a Utilization Management Support Specialist I for on-site support. The role involves assisting in peer-to-peer reviews, communication with providers, and maintaining performance standards within the healthcare sector. Candidates must have a solid understanding of health plan structures and strong communication skills. This is an opportunity to contribute to a team focused on healthcare quality and efficiency.

Qualifications

• Experience in healthcare required.
• Strong written and verbal communication skills necessary.
• Ability to build strong interpersonal relationships.

Responsibilities

• Assist in physician advisor process for cases.
• Provide non-clinical support to workflows.
• Document task completion in internal systems.
• Prepare administrative and clinical denial letters.

Skills

Health plan benefit structure understanding

Psychiatric/medical terminology familiarity

Strong verbal and written communication skills

Interpersonal effectiveness

Personal accountability

Adaptability

Education

Associate degree

Job description

ATTENTION MILITARY AFFILIATED JOB SEEKERS- Our organization works with partner companies to source qualified talent for their open roles. The following position is available toVeterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Unless specifically stated otherwise, this role is "On-Site" at the location detailed in the job post.


Required experience/skills:
Understands health plan benefit structures.
Familiarity with psychiatric/medical terminology.
Strong verbal and written communications skills.
Possesses initiative and interpersonal effectiveness
Is personally accountable and adaptable.
Is effective at building strong interpersonal work relationships.




Schedule

Tuesday - Saturday 9:30am - 6:00pm Central Time

Assists in the physician advisor process for cases sent for peer-to-peer review. Supports the scheduling of reviews, communicating the results and completing the required verbal and written correspondence.

Provides non-clinical support to workflows involving utilization management.
Performs outreach contact to providers and written notification to providers and members for initial determinations.
Consults with internal departments to ensure cases meet guidelines.
Researches cases referred to peer review and contacts the facility to schedule a physician-to-physician review.
Documents task completion in applicable internal systems.
Maintains the integrity of the company relationship with stakeholders by researching and responding to provider needs.
Identifies risk situations and escalates to supervisor as appropriate.
Achieves and maintains department and individual performance standards.
Prepares administrative, approval and clinical denial letters as assigned.
Reviews completed denial letters to ensure accuracy, template use and within the appropriate grade level.
Troubleshoots issues noted on letters by coordinating with team members and physicians to ensure clear and accurate letters. Completes data validation for data entry on letters (address, dates, and other fields as applicable).
Assumes responsibility for self-development, career progression and ongoing training to ensure accuracy of work.
Assists in the mentoring and training of new UM Support Specialists.
Coordinates and manages distribution of correspondence and materials to enrollees and providers.
Participates in operational activities, including data collection, tracking, and analysis.

Additional Qualifications/Responsibilities
Understands health plan benefit structures.
Familiarity with psychiatric/medical terminology.
Strong verbal and written communications skills.
Possesses initiative and interpersonal effectiveness
Is personally accountable and adaptable.
Is effective at building strong interpersonal work relationships.

General Job Information

Title
Utilization Management Support Specialist I

Grade
19

Work Experience - Required
Healthcare

Work Experience - Preferred

Education - Required

Education - Preferred
Associate

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:
$37,725

Salary Maximum:
$56,595