Utilization Review Specialist Team Lead
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Job Location:
Roseburg, OR - USA
Hourly Salary:
USD 48000 - 50000
Posted on:
14 hours ago
Vacancies:
1 Vacancy
Job Summary
HYBRID must be able to travel to 3031 NE STEPHENS ST. ROSEBURG OR 97470
EMPLOYMENT TYPE: Full-Time Exempt
About Umpqua Health
POSITION PURPOSE
The Utilization Review Specialist Team Lead provides support to Umpqua Health Alliance (UHA) in the intake processing and finalization of prior authorizations received by Medical Management in compliance with regulatory requirements. This role provides day-to-day operational support to the Utilization Management (UM) department by assisting with workflow coordination staff guidance and process oversight for non-licensed team members. The Team Lead serves as a key resource to ensure work queues are managed efficiently productivity and turnaround time expectations are met and departmental processes are consistently followed. This position also supports managers with staff training onboarding and mentoring while helping identify workflow issues and opportunities for process improvement. Additionally the Team Lead acts as a primary operational point of contact for team members assisting with workload coordination addressing questions and escalating issues as needed. This role supports efficient UM operations while ensuring compliance with organizational policies and regulatory requirements.
ESSENTIAL JOB RESPONSIBILITIES
Providedaily operational support for Utilization Review and Care Coordination related to prior authorizations.
Manage intake tracking processing and routing of prior authorizations appeals grievances and related documentation.
Monitor work queues to ensuretimelyprocessing and compliance with turnaround requirements.
Prioritize urgent or time-sensitive requests and route appropriately to clinical staff.
Coordinate workflow distribution and telephone coverage among team members.
Serve as a resourceregardingworkflows systems and standard procedures.
Troubleshoot routine operational issues and escalate complex concerns as needed.
Respond to and route internal and external prior authorization inquiries appropriately.
Assistwith onboarding training andmaintainingworkflow and training materials.
Conduct quality reviews to ensure accuracy completeness andtimelyprocessing.
Identifyworkflow trends and process improvement opportunities and report findings to leadership.
Support audits reporting quality improvement initiatives and system or workflow updates.
Participate in departmental meetingstrainings and compliance activities.
Maintain knowledge of applicable regulations policies and compliance requirements.
Working with a variety of personalitiesmaintaininga consistent and fair communication style.
Satisfying the needs of afast-pacedand challenging company.
Balancing regulatory compliance member-centered care and operational efficiency in a complex and evolving CCO environment.
High school diploma or equivalent
Proficient computer skills including MS Office (Word Excel Outlook) data entry internet research and basic office systems (e.g. web-based phone queues cloud document storage)
Ability to type at least 45 wpm with a high degree of accuracy
High attention to detail with strong accuracy in data entry and documentation
Ability to manage multiple priorities organize work and meet deadlines in a fast-paced environment
Strong interpersonal written and verbal communication skills with the ability to interact professionally with internal and external customers
Ability to work effectively both independently and as part of a team whilemaintainingconfidentiality
Willingness to learn new skills and take on new responsibilities
Ability to work remotely MondayFriday 8:00 AM5:00 PM PST
No suspension exclusion or debarment from federal healthcare programs (e.g. Medicare/Medicaid)
Valid drivers license and current automobile insurancerequired.
1 years of experience in healthcare managed care (utilization) medical coding claims or related field
Knowledge of medical terminology procedure codes and diagnosis codes
Familiarity with Oregon Health Plan (OHP) and Coordinated Care Organizations (CCO) including OAR ORS CFR CMS DMAP and the Prioritized List of Health Services
Experience working in diverse teams and with varied communication styles
Experience considering health equity impacts in analytical or operational work
Bilingual or translation capabilities preferred
Strong critical thinking and time management skills to prioritize workload and meet turnaround times consistently
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $48000- $50000
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
Why Umpqua Health
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.
Equal Opportunity
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
