Utilization Management Specialist

About the Role

Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement.

Responsibilities

• Understands and accesses insurance websites.
• Completes required duties as defined for specific payers to obtain authorization numbers for payment.
• Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status.
• Utilizes electronic medical record work queues that support Utilization Management functions.
• Answers incoming calls or places outbound calls with appropriate communication skills. Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
• Problem solves issues that are received via phone, fax or email.
• Other duties as assigned.

Qualifications

• Required: High School Diploma or equivalent
• Preferred: 2 years of relevant healthcare experience
• Preferred: Post high school training and/or academic coursework leading toward associate’s or bachelor’s degree

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on restaurants, phone plans, spas, and more
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings

Schedule

• Employment Type: Part time
• Shift: Day (United States of America)
• Weekly Scheduled Hours: 8
• Hours of Work: 8:00 a.m. - 4:30 p.m.
• Days Worked: Monday - Friday
• Weekend Frequency: N/A

Primary Location: SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

Department: Utilization Management - Diversified East WB Mkt