Utilization Management Administrator

Overview

• Provide administrative support in utilization management, ensuring efficient communication and resolution of provider and member issues.
• Handle inbound and outbound communications, managing caseloads effectively using internal tools and resources.
• Collaborate with internal teams to identify trends and resolve roadblocks impacting member and provider satisfaction.
• Perform data entry and case building tasks with attention to HIPAA compliance and accuracy.
• Support utilization review activities and manage documentation and correspondence efficiently.
• Utilize advanced computer literacy skills to navigate CRM, ticket management, and reporting tools.
• Adhere to all applicable laws and regulations, ensuring compliance in all tasks.
• Work remotely, leveraging technology such as MacBook and Google applications for effective operations.

Key Responsibilities & Duties

• Handle inbound and outbound provider calls and email communications to address issues and concerns.
• Manage assigned caseloads and queue work through efficient dashboard utilization.
• Investigate and resolve issues within established service level agreements (SLAs).
• Collaborate with colleagues and leads to identify trends and roadblocks affecting satisfaction.
• Perform data entry and case building tasks with precision and compliance.
• Support utilization review activities and manage documentation and correspondence.
• Effectively communicate findings and resolutions with providers and internal departments.
• Comply with all applicable laws and regulations in daily operations.

Job Requirements

• High School Diploma or GED required; advanced computer literacy preferred.
• 1+ years of customer support/service experience, preferably in healthcare or SaaS environments.
• Experience with CRM, ticket management, and reporting tools for resolving client issues.
• Proficiency in managing assignment caseloads and performing data entry tasks.
• Strong ability to use technology, including MacBook and Google applications.
• Background in utilization review and remote work experience preferred.
• Availability for flexible shifts within 8 AM – 8 PM ET, including weekends.