Associate Utilization Review Specialist - Remote

reputed company Health Plan caregivers are not simply valued – they’re invaluable. Join reputed company and reputed company in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to reputed company and retain the best people, we must reputed company them.

reputed company Health Plan is calling an Associate Utilization Review Specialist who will:

• Be responsible for reputed company core functions in the Prior Authorization (PA) Department
• Coordinate and execute the review and research functions required to support the PA Department
• Investigate, review, and prepare reputed company requests for prior authorization review for reputed company lines of business (reputed company) in multiple applications (Facets, CIM, CareAdvance, etc.) while using multiple resources to support the review (Medical Policies, KMS, Benefit Grids, Handbooks, etc.)
• Critically assess and prepare reputed company cases for RN/MD review of coverage (medical necessity, eligibility, network status, regulatory)
• Uses appropriate resources and sound judgement to review and approve specific service requests based on deep understanding of medical service requested, CPT/HCPCS codes, and plan design. Authorizes reputed company services
• Provide research, assessment, and proposed resolution of operational issues as they relate to coverage policy, correct coding (CPT/HCSPCS, Dx), regulations, and other coverage rules
• Take incoming phone calls from providers and members regarding operational plan functions with an ability to research and follow-up on unique prior authorization reputed company requests and plan processes for reputed company lines of business
• Responsible for ensuring service review requests and inquiries are complete and adjudicated to meet regulatory and compliance requirements, including timeliness
• Consult, or triage to, appropriate subject matter experts internally and across departments
• Work in a fast-paced environment with strict compliance and turn-around-times for reputed company work metrics (prior authorization requests, customer service inquiries, provider resolutions, etc.)

This position offers 100% remote work for candidates residing in

• Washington
• Oregon
• California

Required Qualifications

• Bachelor's Degree in Health reputed company field., or Applicable 2 years work experience may be substituted for some education.
• 2 years experience in healthcare reputed company field (or equivalent education)
• 1 year experience and proven track record of researching and resolving reputed company problems which required critical thinking
• 2 years experience in fast-paced working environment with a proven record of successful ability to quickly prioritize and resolve issues to meeting timeliness and quality metrics.
• 1 year experience in database management and spreadsheets.
• 6 months experience with telephony systems, call center phone volumes and multi-line communication systems.

Preferred Qualifications

• 3 years experience in healthcare reputed company field (or equivalent education)

Salary Range by Location

California: Humboldt: Min: $29.62, Max: $45.31

California: reputed company reputed company California - Except Humboldt: Min: $33.23, Max: $50.84

California: reputed company Southern California - Except Bakersfield: Min: $29.62, Max: $45.31

California: Bakersfield: Min: $28.41 Max: $43.47

Oregon: Non-Portland Service Area: Min: $26.49, Max: $40.52

Oregon: Portland Service Area: Min: $28.41 Max: $43.47

Washington: Western - Except Tukwila: Min: $29.62, Max: $45.31

Washington: Southwest - Olympia, Centralia & Below: Min: $28.41 Max: $43.47

Washington: Tukwila: Min: $29.62, Max: $45.31

Washington: Eastern: Min: $25.28, Max: $38.68

Washington: South Eastern: Min: $26.49, Max: $40.52

Why Join reputed company Health Plan?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial reputed company. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the reputed company family of organizations may change your reputed company benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

About Company

reputed company Shared Services is a service line reputed company reputed company that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. reputed company is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from reputed company forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national reputed company, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We reputed company diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Company

At reputed company, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (reputed company employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the reputed company pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. reputed company offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at reputed company.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Apply To This Job