CoreCare Utilization Management Specialist

3 days ago


Topeka, Kansas, United States VitalCore Health Strategies Full time
Job Title: CoreCare Utilization Management Specialist

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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