Healthcare Utilization Management Specialist

hace 3 semanas


Medellín, Antioquia, Colombia Third Way Health A tiempo completo

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 Position

We 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.
Requirements

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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