Utilization Management Specialist

NeoWork is currently seeking a highly organized and detail-oriented Utilization Management Specialist to join our team. As a Utilization Management Specialist, you will play a crucial role in managing the utilization of healthcare services, ensuring optimal patient care and cost-effective utilization of resources.

NeoWork is committed to providing comprehensive and efficient healthcare solutions. The Utilization Management (UM) Specialist will execute workflows to support outreach to Physical Therapists (PTs) in order to meet various UM goals. This includes therapist outreach via chats, tracking, and auditing UM form completion. The role also supports various Clinical Success workflows, such as auditing schedule/discharge status, providing exercise chat support, and managing outcome exclusion chats.

We are looking for someone with strong analytical skills, knowledge of healthcare regulations, and the ability to make sound decisions. The ideal candidate should have a background in healthcare administration or a related field, with a focus on utilization management.

Responsibilities

• Daily 50-100 chats, 50-100 audits, 10-15 follow-ups.
• Review and evaluate requests for medical treatments, procedures, and services
• Assess medical necessity, appropriateness, and cost-effectiveness of requested services
• Ensure compliance with healthcare regulations and company policies
• Collaborate with healthcare professionals to gather necessary information and clarify medical documentation
• Communicate decisions and provide explanations to patients, healthcare providers, and insurance companies
• Maintain accurate and detailed records of utilization management activities
• Conduct utilization audits and identify areas for improvement
• Stay updated on industry trends and best practices in utilization management

Requirements

• Bachelor's degree in healthcare administration or related field
• At least 2 years of experience in utilization management or a similar role
• Strong analytical and problem-solving skills
• Knowledge of healthcare regulations and guidelines
• Excellent communication and interpersonal skills
• Ability to make sound decisions and exercise judgment
• Attention to detail and ability to maintain accuracy in a fast-paced environment
• Proficiency in using healthcare management software and tools
• Owned computer or laptop and stable internet connectivity.
• Knowledgeable in Office 360, Google Apps, and client-facing communication.

Benefits

• We provide comprehensive training for all candidates, regardless of their background or previous experience as a VA.
• The work hours generally align with standard business hours in the US, with some potential flexibility depending on the client's needs.
• This is a 100% home-based position
• We prioritize the mental health of our team members and offer mental health days to support their well-being.
• In addition to the base salary, performance-based incentives are provided.
• There is an annual review and appraisal process in place.
• There are ample opportunities for professional growth and advancement within the company.