Healthcare Utilization Management Specialist
hace 3 semanas
Third Way Health is dedicated to enhancing the patient experience and reducing administrative burdens on medical practices. We achieve this by providing a cutting-edge technology platform and exceptional services.
About the PositionWe are seeking a full-time Utilization Management agent to join our team in the Medellin area. As a valued member, you'll play a crucial role in improving healthcare experiences for thousands of patients and providers in the US.
Job Responsibilities- Perform 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 as needed 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.
- Undertake any other job-related responsibilities as assigned to support team objectives and contribute to overall operational success.
- Accurately log cases in software platforms to track and manage healthcare processes.
To succeed in this role, you will need:
- University or associate degree preferred.
- At least 8 months of experience in health insurance.
- Strong communication skills (fluent in English and Spanish, C1 or above preferred).
- Expertise in healthcare, particularly in the US sector, and managing call center operations.
- Excellent active listening skills, patience, and empathy.
- 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.
- Phone skills, including familiarity with complex phone systems.
This role requires $55,000 - $65,000 per annum, depending on experience and qualifications.
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