Radiation Oncology Utilization Splst

Legacy Health•Portland, OR

9h•$30 - $43

About The Position

The Utilization Review/Utilization Management (UR/UM) Specialist is responsible for reviewing medical services for appropriateness, medical necessity, and efficiency. This role ensures that patient care aligns with established guidelines and payer policies while optimizing resource utilization. The specialist collaborates with healthcare providers, insurance companies, and case management teams to facilitate timely authorizations and appeals when necessary.

Requirements

Associate's or Bachelor's degree in Radiation Therapy, Health Administration, or a related field preferred.
2-5 years oncology experience.
Utilization review or prior authorization experience required.
2-5 years in utilization review, case management, or prior authorization, preferably in a hospital or managed care setting.
Strong understanding of medical necessity criteria, insurance policies, and reimbursement guidelines.
Proficiency in electronic medical records (EMR), payer portals, and utilization management software.
Excellent communication and problem-solving skills.
Ability to work independently and manage multiple cases simultaneously.
Knowledge of regulatory requirements (e.g., Medicare, Medicaid, commercial insurance).

Responsibilities

Reviewing medical services for appropriateness, medical necessity, and efficiency.
Ensuring patient care aligns with established guidelines and payer policies.
Optimizing resource utilization.
Collaborating with healthcare providers, insurance companies, and case management teams.
Facilitating timely authorizations and appeals when necessary.