Healthcare Utilization Specialist
hace 2 semanas
About Third Way Health
Third Way Health, Inc. is a leading provider of technology and services to improve the patient experience and reduce administrative burden on practice owners and management.
Position Overview
We are seeking a full-time Utilization Management agent to join our team in the Medellin area. As a valued member of our team, you will play a crucial role in enhancing the healthcare experience for thousands of patients and providers in the US.
Responsibilities
- Conduct thorough prior authorization and retrospective reviews for elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment to ensure compliance and appropriate utilization.
- Make necessary calls to ensure all parties are aligned throughout the process.
- Assess and refer cases to Medical Directors when necessary, ensuring timely and accurate decision-making for complex cases.
- Stay updated on state and federal regulations, as well as accreditation standards, to ensure all processes meet required guidelines and industry standards.
- Follow internal policies and procedures diligently to maintain operational efficiency and uphold quality standards within the team.
- Accurately log cases in software platforms to track and manage healthcare processes.
Requirements
- University or associate degree preferred.
- Required knowledge in health insurance (at least 8 months).
- Strong communication, both written and verbal (candidates must be fluent in English and Spanish, C1 or above preferred).
- Expertise in healthcare (US healthcare sector experience; does not need to be a nurse or doctor) and managing call center operations.
- Great active listening skills.
- A patient and empathetic attitude.
- Strong time management and organizational skills.
- Adaptability and flexibility.
- Comfortable working in fast-paced environments.
- Excellent troubleshooting skills.
- Computer literacy and proven track record of working in multiple systems in parallel.
- Phone skills, including familiarity with complex or multi-line phone systems.
We are committed to creating a positive and supportive work environment where our employees can thrive.
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