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Utilization Management Specialist

4 months ago

Remote, Oregon, United States Equip Full time

About Equip

Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower individuals to reach lasting recovery. All Equip patients receive a dedicated care team, including a therapist, dietitian, physician, and peer and family mentor. The company operates in all 50 states and is partnered with most major health insurance plans. Learn more about our strong outcomes and treatment approach at

Founded in 2019, Equip has been a fully virtual company since its inception and is proud of the highly-engaged, passionate, and diverse Equisters that have created Equip's culture. Recognized by Time as one of the most influential companies of 2023, along with awards from Linkedin and Lattice, we are grateful to Equipsters for building a sustainable treatment program that has served thousands of patients and families.

About the role

The Utilization Management Specialist will be responsible for obtaining timely authorizations form health plans, acting as a liaison between insurance companies, the Admissions team, and the Clinical team. The Utilization Management (UM) Specialist will manage both initial and ongoing insurance authorizations and operations, ensuring accurate treatment and authorization information is communicated to insurance companies and internal stakeholders.

Responsibilities:

  • Develop collaborative relationships with insurance companies/payors to submit and track prior authorizations and concurrent reviews.
  • Synthesize large amounts of qualitative and quantitative clinical data into compelling authorization requests.
  • Escalate cases requiring peer review to the Utilization Manager.
  • Assist with appealing authorization denials.
  • Respond to inquiries from insurance companies and internal team members.
  • Work collaboratively with the Finance, Revenue Cycle, Admissions and Clinical departments.
  • Maintain confidentiality of patient care and business information. Perform other duties as assigned.

Qualifications:

  • 3+ years of healthcare experience within utilization management, billing, insurance verification, or direct patient care.
  • Knowledge and experience with EMR systems.
  • Strong verbal and written communication.
  • Strong professional interpersonal skills with demonstrated ability to effectively collaborate with external and internal stakeholders.
  • Strong attention to detail with demonstrated ability to consistently follow processes.
  • Strong organizational and time management skills with a proven track record of meeting assigned deadlines and goals.
  • Familiarity with HIPAA privacy requirements for patient information. Ability to maintain and protect confidential information.
  • Excellent organizational awareness, adaptability, and conflict management skills.
  • A passion for living Equip's mission and values.
  • Comfortable with ambiguity and ability to think critically to quickly and accurately work through challenges in a fast-paced, fluid environment.

Physical Demands

Work is performed 100% from home with no requirement to travel. This is a stationary position that requires the ability to operate standard office equipment and keyboards as well as to talk or hear by telephone. Sit or stand as needed.

At Equip, diversity, equity, inclusion and belonging are woven into everything we do. At the heart of Equip's mission is a relentless dedication to making sure that everyone with an eating disorder has access to care that works regardless of race, gender, sexuality, ability, weight, socio-economic status, and any marginalized identity.

As an equal opportunity employer, we provide equal opportunity in all aspects of employment, including recruiting, hiring, compensation, training and promotion, termination, and any other terms and conditions of employment without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, gender expression, familial status, age, disability, weight, and/or any other legally protected classification protected by federal, state, or local law.