CoreCare Utilization Management Specialist
3 days ago
VitalCore Health Strategies is seeking a highly skilled CoreCare Utilization Management Specialist to join our team in Kansas. As a key member of our team, you will be responsible for reviewing and analyzing medical data to ensure accurate and timely authorization of patient services.
Key Responsibilities:
- Conduct thorough reviews of medical data to ensure compliance with clinical and benefits administration guidelines
- Provide accurate and timely medical authorization information to clinicians, vendors, and providers
- Collaborate with UM RN staff to escalate decisions that require clinical review and oversight
- Communicate results of reviews to the primary care team and clinical reviewers
- Ensure adherence to department and organizational policies and procedures, as well as applicable regulatory, contractual, and compliance requirements
Requirements:
- Associate's Degree or equivalent experience
- Certification in Medical Coding
- 10+ years of professional work experience in healthcare, managed care, or insurance
- English required, bilingual preferred
- Proficient in Microsoft Suite, specifically Excel
Benefits:
- Holiday Pay
- Medical
- Dental
- Vision
- Health Savings Account
- Life Insurance
- Short Term/Long Term Disability
- Identity Theft Protection
- Pet Insurance
- Employee Assistance Program and Discount Center
- 401K & Plan Matching
- PTO
- Dependent Care Flexible Spending Account
- Annual Incentive Bonus
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Topeka, Kansas, United States VitalCore Health Strategies Full timeCoreCare Utilization Management SpecialistVitalCore Health Strategies is seeking a highly skilled CoreCare Utilization Management Specialist to join our team. As a key member of our Utilization Management team, you will be responsible for reviewing and analyzing medical data to ensure accurate and timely authorization of patient services.Key...
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CoreCare Utilization Management Specialist
1 week ago
Topeka, Kansas, United States VitalCore Health Strategies Full timeJob Title: CoreCare Utilization Management SpecialistJob 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....
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