Utilization Review Specialist
Job Location:
Roseburg, OR - USA
Yearly Salary:
Posted on:
Vacancies:
Job Summary
Utilization Review Specialist
HYBRID must be able to travel to 3031 NE STEPHENS ST. ROSEBURG OR 97470
EMPLOYMENT TYPE- Full-Time Exempt
POSITION PURPOSE
TheUtilization Review Specialist supports Umpqua Health Alliance by coordinating the intake review processing and completion of prior authorization requests within Medical Management. This roleis responsible forensuringaccurateandtimelyhandling of authorizationsmaintainingcompliance with regulatory and organizational requirements supporting communication with providers and members andassistingwith workflow coordination to promote efficientutilizationmanagement operations.
ESSENTIAL JOB RESPONSIBILITIES
Support Utilization Review activities related to the prior authorization process.
Manage intake tracking and routing of prior authorization requests and supporting documentation.
Review requests for completeness and ensureappropriate routingfor processing.
Communicate with healthcare providers to obtainadditionalinformation and resolve documentation issues.
Track prior authorization requests using established systems to ensuretimelyprocessing.
Supporttimelynotification of prior authorization determinations.
Coordinate daily workflow and telephone coverage with team members.
Respond to internal and external inquiriesregardingprior authorizations androuteasappropriate.
Monitor and report on turnaround times to ensure compliance with requirements.
Maintain knowledge of applicable regulations policies and procedures.
Comply withorganizational policies andapplicable tofederal state and local regulations.
Strong organizational skills with the ability to stay organized and productive in a remote independent work environment
Proactive communication with internal and external stakeholders
Consistent ability to meet Oregon Health Plan (OHA) timeline and turnaround requirements
Ability to manage shifting priorities in a fast-paced environment
Ability to coordinate tasks and resources to meet operational goals andobjectives
- High school diploma or equivalent.
- Proficient computer skills including Microsoft Office Suite (Word Excel Outlook Teams) data entry and internet research.
- Experience using standard office equipment and systems including keyboarding web-based phone systems and cloud-based document storage.
- Ability to type a minimum of 45 words per minute with a high degree of accuracy.
- Strong attention to detail.
- No suspension exclusion or debarment from participation in federal healthcare programs (e.g. Medicare/Medicaid)
1 years of experience in healthcare managed care medical coding claims processing or a related field
Knowledge of medical terminology procedure codes and diagnosis codes
Familiarity with Oregon Health Plan (OHP) and Coordinated Care Organizations (CCO) including applicable regulations (OAR ORS CFR CMS DMAP)
Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
Ability to meet deadlines whilemaintainingaccuracy and attention to detail
Strong communicationand customer service skills (written verbal and interpersonal)
Ability to work independently and collaboratively with sound judgment and confidentiality
Strong critical thinking and time management skills
Self-motivated with ability to follow policies procedures and workflows in a remote environment
Flexible and adaptable in a changing work environment
Willingness to learn and take onadditionalresponsibilities as needed
Ability to work a standard schedule: MondayFriday 8:00 AM5:00 PM PST
Experience working in diverse teams and with varied communication styles
Experience considering the impact of work on diverse communities including communities of color
Bilingual or translation skills preferred
SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band : $41600- $47000
BENEFITS
- Salary is dependent on skills experience and education
- Generous benefits package including vacation PTO sick leave federal holidays and birthday leave
- Medical dental and vision insurance
- 401(k) with company match (fully vested immediately)
- Company-sponsored life insurance and additional benefits
- Fitness reimbursement program
- Tuition reimbursement and more
Inclusive Culture
We foster a respectful inclusive environment where employees feel valued supported and empowered.
Growth & Development
We support ongoing learning through mentorship clear career pathways and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Required Experience:
Junior IC
About Company
UMPQUA HEALTH Quality, Local Care for Douglas County Member Services As a member of Umpqua Health, you have access to many different benefits and programs. Whether you’re a new member, or you’ve been with us for years, we’re here to help! Provider Services We’re here to help you deliv ... View more
