
Job Information
Randstad Utilization Management Specialist in Watertown, Massachusetts
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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