Utilization Management Professional

3 days ago


Madison, Wisconsin, United States Quartz Full time

The Utilization Management Professional plays a vital role in ensuring the quality and cultural competence of overall healthcare service delivery at Quartz. This role involves working closely with members and providers to coordinate care and services, and serving as the primary contact for Utilization Management inquiries.

About the Role

This full-time position requires strong communication and analytical skills, with the ability to work effectively in a fast-paced environment. The ideal candidate will have a strong understanding of healthcare operations and be able to collaborate with cross-functional teams.

Key Responsibilities
  • Reviewing and processing select prior authorization requests for completeness
  • Collaborating with RN team to identify and prioritize high needs/risk cases
  • Conducting telephonic customer service and problem-solving for members and providers
  • Triage outpatient and customer service urgent prior authorization requests
Requirements

We're looking for a highly motivated individual with:

  • Associate degree or equivalent work experience in a health-related field
  • ~3+ years of experience working in health plan or healthcare-related operations role
  • Knowledge of medical terminology, including ICD-10 and CPT/HCPCS coding (CPC certification preferred)
  • Electronic health record experience preferred (i.e., EPIC)
  • Advanced Microsoft Office skills
Benefits

Quartz offers a competitive salary range of $55,000 - $65,000 per year, depending on experience, plus an excellent benefit package, opportunities for career advancement, and a professional culture built upon Respect, Responsibility, Relationships & Resourcefulness. We are proud to be an Equal Employment Opportunity, Affirmative Action employer and value diversity and inclusion.



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