NEW JOB OPENING
UTILIZATION MANAGEMENT SPECIALIST
IN Everett, WA, USA!

 

Date Posted: 04/09/2024
Hiring Organization: Rose International
Position Number: 462002
Job Title: Utilization Management Specialist
Job Location: Everett, WA, USA, 98203
Work Model: Hybrid
Shift: Remote position, Monday-Friday 8:30-5 pm
Employment Type: Temp to Hire
Estimated Duration (In months): 5
Min Hourly Rate($): 22.00
Max Hourly Rate($): 22.50
Must Have Skills/Attributes: Administrative, Healthcare

 

Job Description

  • **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

  • **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**

Need Local Washington state candidates, but the position is REMOTE unless there are tech issues, then you need to come into the office until resolved.
Potential to go FTE only if they have an opening and the candidate excels in the role.




The Utilization Management Specialist implements, maintains, and executes procedures and processes by which our company performs its referral and authorization process.
This position responds to inquiries from patients, staff, and physicians about referral authorization questions.
The position also researches medical history and diagnostic tests when requested, to assist in review, processing, and coordination of prospective, concurrent, and retrospective referrals.

Primary Responsibilities:
Initiate Referral Authorizations
• Acquires and maintain a working knowledge of Optum contracted health plans agreements and related insurance products
• Provides administrative and enrollment support for the team to meet Company goals
• Gathers information from relevant sources for processing referrals and authorization requests
• Submits authorization & referral requests to health plan via the avenue of insurance requirement.

Including but not limited to website, phone, & fax
• Track authorization status inquiries for timely response
• Maintains a strong understanding of and educates our physicians, clinical teammates, patients, and families regarding contracted health plan requirements related to Utilization Management and authorizations.
• Acts as a liaison between providers, teammates, outside vendors, health plans, community services, and patients to support the Utilization Management process and requirements
• Reviews benefit language and medical records to assist in the completion of requested services, to meet health plan requirements
• Documents patient information in the electronic health record following standard work guidelines
• Coordinates with Clinical teammates and health plans to identify patients with Utilization Management needs
• Provides member services to all patient group
• Answers referral and authorization inquiries from health plans, our clinical areas, patients, and outside Optum Physician office/facilities
• Assists in the development and implementation of job-specific policies and procedures
• Assists in the collection of information for member and/or provider appeals of denied requests
• Identifies areas for potential improvement in patient satisfaction

 

Benefits:
For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.

California Pay Equity:
For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.

Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

 

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About Rose

  • Founded in 1993
  • Office Locations Across the U.S.
  • 150+ Clients: Corporations and Government Agencies
  • Employee Oriented Company
  • Challenging Assignments Across the U.S.
  • Continuous Professional Development

As a contractor, I have to say that Rose International was by far the best agency I have worked for.

Q'testdalir, Consultant

I believe the best thing that Rose HR has going for it is the incredible responsiveness. Everyone is very quick to reply to any concerns, and contacts the contracted employees very quickly and efficiently.

Kevin, Consultant

The interactions that I have had with your representatives have always been prompt and very professional. I am very pleased and impressed with your company and services.

Sioe, Consultant

Your team at Rose International is always very helpful and responsive.

Barbara, Consultant

Each time I contacted Rose, I was completely satisfied with the great attention and customer service I received. Each person was extremely knowledgeable and patient with my concerns or questions.

Diana, Consultant

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