CoreCare Utilization Management Specialist
1 week ago
Job Summary:
VitalCore Health Strategies is seeking a skilled CoreCare Utilization Management Specialist to join our team. As a key member of our healthcare team, you will be responsible for reviewing patient data to ensure accurate application of clinical and benefits administration procedural guidelines. Your expertise will help us provide high-quality care to our patients while maintaining compliance with regulatory requirements.
Key Responsibilities:
* Review patient data to confirm accurate application of clinical and benefits administration procedural guidelines
* Provide accurate and timely medical authorization information to clinicians, vendors, and providers
* Analyze medical billing and identify documentation deficiencies
* Conduct preliminary decision reviews for services requiring prior authorization
* Work closely with UM RN staff to escalate decisions that require clinical review and oversight
Requirements:
* Associate's degree or equivalent experience
* Certification in medical coding
* 10+ years of professional work experience in healthcare, managed care, or insurance
* Excellent communication and problem-solving skills
* Proficient in Microsoft Suite, specifically Excel
Benefits:
* Competitive wages
* Annual incentive bonus
* Excellent benefits package
Work Environment:
VitalCore Health Strategies is an equal opportunity employer committed to creating a diverse and inclusive workplace. We offer a positive work environment that values respect, appreciation, and hard work.
How to Apply:
If you are a motivated and detail-oriented professional with a passion for healthcare, please submit your application. We look forward to reviewing your qualifications and discussing this opportunity further.
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