Healthcare Utilization Specialist

hace 2 semanas


Medellín, Antioquia, Colombia Third Way Health, Inc. A tiempo completo

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

  1. 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.
  2. Make necessary calls to ensure all parties are aligned throughout the process.
  3. Assess and refer cases to Medical Directors when necessary, ensuring timely and accurate decision-making for complex cases.
  4. Stay updated on state and federal regulations, as well as accreditation standards, to ensure all processes meet required guidelines and industry standards.
  5. Follow internal policies and procedures diligently to maintain operational efficiency and uphold quality standards within the team.
  6. Accurately log cases in software platforms to track and manage healthcare processes.

Requirements

  1. University or associate degree preferred.
  2. Required knowledge in health insurance (at least 8 months).
  3. Strong communication, both written and verbal (candidates must be fluent in English and Spanish, C1 or above preferred).
  4. Expertise in healthcare (US healthcare sector experience; does not need to be a nurse or doctor) and managing call center operations.
  5. Great active listening skills.
  6. A patient and empathetic attitude.
  7. Strong time management and organizational skills.
  8. Adaptability and flexibility.
  9. Comfortable working in fast-paced environments.
  10. Excellent troubleshooting skills.
  11. Computer literacy and proven track record of working in multiple systems in parallel.
  12. 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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