Utilization Management (Pre- Auth) REMOTE

Portland, TX - USA

Monthly Salary: Not Disclosed

Posted on: 4 days ago

Vacancies: 1 Vacancy

Job Summary

Position: Facets UM Consultant with pre-Auth

Experience: -10Years

Location: -Remote (PST TIME ZONE)

Responsibilities: -

A Facets UM Consultant is responsible for providing customers with application domain expertise related to Utilization Management rules and processes within the Facets platform.
Review and analyze FACETS Pre-Auth/UM rules for state-specific customization.
Evaluate rule logic for authorization routing benefit limits and medical necessity guidelines.
Identify gaps affecting intake determination and UM workflows. Work closely with UM operations clinical teams and configuration groups.
5 - 8 years in UM/Pre-Auth configuration within FACETS.
Familiarity with UM workflows clinical guidelines and state mandates.
Experience working with clinical/utilization management stakeholders.
Deep understanding of US Healthcare payer operations.
Ability to analyze complex rules and configurations.

Educational Qualifications: -

Engineering Degree BE/ME/BTech/MTech/BSc/MSc.

Technical certification in multiple technologies is desirable.

Position: Facets UM Consultant with pre-Auth Experience: -10Years Location: -Remote (PST TIME ZONE) Responsibilities: - A Facets UM Consultant is responsible for providing customers with application domain expertise related to Utilization Management rules and processes within the Facets platform. ...