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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

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.

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