Utilization Management Assistant

Advocate Health and Hospitals Corporation•Wake Forest, NC

21h•$22 - $33•Onsite

About The Position

The Utilization Management Assistant provides essential administrative and operational support to the Utilization Management (UM) function within the Department of Care Coordination . This role works collaboratively with Care Coordination staff, Utilization Review nurses, Physician Advisors, medical center departments, and external payer partners to ensure timely, accurate exchange of clinical and authorization information. The ideal candidate thrives in a fast‑paced healthcare environment, demonstrates strong attention to detail, and consistently delivers excellent customer service while supporting patient care and regulatory compliance.

Requirements

High school diploma required
Two (2) years of administrative or office experience, preferably in a healthcare setting preferred
Proficiency with Microsoft Office applications required
Strong typing, data entry, and documentation skills
Excellent interpersonal, communication, and customer service skills
Ability to organize, prioritize, and manage multiple tasks simultaneously
Ability to handle a high volume of phone calls and frequent interruptions
Demonstrated attention to detail and commitment to accuracy and confidentiality

Nice To Haves

Associate’s degree in a health‑related field preferred

Responsibilities

Manage incoming fax, phone, portal, mail, and other communication from internal and external customers related to clinical requests, authorizations, approvals, and denials
Determine appropriate action for incoming requests and accurately document all activities in designated databases and areas of the Electronic Health Record (EHR)
Communicate clinical needs, authorizations, and denials to Utilization Review (UR) nurses and UM leadership for follow‑up
Relay information to third‑party payers on behalf of Case Managers via phone, fax, and electronic portals
Proactively follow up with payers to validate authorizations, confirm approved days, and accurately capture approved days in the EHR
Verify insurance information received via phone, fax, or portal and provide requested information to payers, including discharge dates, disposition, and clinical reviews or summaries prepared by UM RNs (as directed)
Ensure all actions comply with confidentiality standards and HIPAA regulations
Receive, track, and document insurance authorizations in the EHR
Assist with audits related to Utilization Management and regulatory compliance
Enter data into databases and spreadsheets and perform data tracking or analysis as directed
Open, sort, and process incoming mail and correspondence directed to Utilization Review
Maintain departmental records and files in accordance with policy
Participate in the Utilization Management Committee by providing administrative and logistical support
Interact with Physician Advisors following established escalation guidelines
Provide efficient, courteous, and professional customer service to all internal and external callers
Perform a variety of general office and administrative duties to support the UM function

Benefits

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and more Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program