Utilization Management Admin

Utilization Management Admin Overview

• The Utilization Management Admin role focuses on providing administrative support in a healthcare environment, ensuring compliance and efficient case management.
• This position offers a remote work arrangement, enabling flexibility and convenience for eligible candidates.
• The role involves data entry, case building, and documentation management with adherence to HIPAA compliance standards.
• Candidates will collaborate across teams to resolve provider and member issues, enhancing satisfaction and care accessibility.
• The position includes handling inbound and outbound communications, utilizing CRM tools for efficient workflow management.
• Training is provided for 4-6 weeks, ensuring readiness for the role's responsibilities and tools.
• Offers a six-month contract with potential for extension or permanent placement based on performance.
• Approved candidates must reside in one of the listed eligible states, ensuring compliance with remote work policies.

Utilization Management Admin Key Responsibilities & Duties

• Handle inbound and outbound provider calls and email communications to resolve issues effectively.
• Manage assigned caseloads and queues using internal dashboards and tools for efficient workflow.
• Perform data entry and case building with attention to detail and HIPAA compliance.
• Collaborate with colleagues and leads to identify trends and resolve roadblocks impacting service delivery.
• Utilize CRM and ticket management tools to track and report on case progress and resolutions.
• Ensure compliance with applicable laws and regulations in all activities and communications.
• Support utilization review activities and perform general administrative duties as assigned.
• Communicate findings and resolutions effectively with providers and internal departments.

Utilization Management Admin Job Requirements

• High School Diploma or GED is required for eligibility.
• Minimum of 1 year of customer service or support experience, preferably in healthcare or SaaS environments.
• Advanced computer literacy, including proficiency with CRM and ticket management tools.
• Experience managing caseloads and performing data entry with attention to detail.
• Ability to work remotely with full flexibility for shifts between 8 AM and 8 PM ET.
• Strong communication skills to handle provider inquiries and collaborate with internal teams.
• Knowledge of HIPAA compliance and healthcare authorization processes is preferred.
• Candidates must reside in one of the approved states listed for this remote position.