Utilization Management Specialist

Corewell Health • Southfield, MI

8d

About The Position

Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement. Essential Functions Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment. Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status. Utilizes electronic medical record work queues that support Utilization Management functions. Answers incoming calls or places outbound calls with appropriate communication skills. Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up. Problem solves issues that are received via phone, fax or email. Other duties as assigned. As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.

Requirements

• High School Diploma or equivalent.

Nice To Haves

• Two years of healthcare experience
• Competency and comprehension of basic medical terminology.
• Well-developed computer skills and/or business-related software/application literacy.

Responsibilities

• Understands and accesses insurance websites.
• Completes required duties as defined for specific payers to obtain authorization numbers for payment.
• Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status.
• Utilizes electronic medical record work queues that support Utilization Management functions.
• Answers incoming calls or places outbound calls with appropriate communication skills.
• Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
• Problem solves issues that are received via phone, fax or email.
• Other duties as assigned.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED