Massachusetts Healthcare Jobs

Utilization Management Specialist

job details:

• location:Watertown, MA

• salary:$15.86 - $18.89 per hour

• date posted:Wednesday, February 3, 2021

• experience:Entry Level

• job type:Temporary

• industry:Health/allied service

• reference:AB_3557145

• questions:alex.demetriades@randstadusa.com617-227-2090

job description

Utilization Management Specialist

Randstad is working with a prestigious well renowned health insurance agency in Watertown to fill a temporary Utilization Management Specialist role. Under the direction of the Pre certification Team Manager the Review Specialist is responsible for the daily management of non-clinical reviews supporting the clinical, business and program related work of the department. The Specialist functions as a key member of the Utilization Management Team and department and is a representative of Tufts Health Plan values to both the internal and external customer through written and verbal communication. The Specialist is responsible for coordination of coverage determinations for special handling of designated products or accounts, all medical necessity denial letters and monitoring of daily processes performed by the UMC.

Responsibilities

Under the direction of the Pre certification Team Manager the Review Specialist is responsible for the daily management of non-clinical reviews supporting the clinical, business and program related work of the department. The Specialist functions as a key member of the Utilization Management Team and department and is a representative of Tufts Health Plan values to both the internal and external customer through written and verbal communication. The Specialist is responsible for coordination of coverage determinations for special handling of designated products or accounts, all medical necessity denial letters and monitoring of daily processes performed by the UMC.

Skills

• Claims Processing

• insurance

• healthcare customer service (1 year of experience is required)

• Administrative Duties

• communication skills (1 year of experience is required)

Education

• Associates (required)

Qualifications

• Years of experience: 0 years

• Experience level:Entry Level

Shift: First

Working hours: 8:30 AM - 5 PM

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