Utilization Mgmt Specialist

Location: Hybrid or remote; candidates must live in Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, or Texas.

Company

hirify.global is a mission-driven health insurance organization focused on member and community well-being.

What you will do

• Receive, maintain, verify, and distribute medical or pharmacy documentation.
• Determine whether medical or pharmacy review decisions are required and coordinate authorizations in the Medical Management System.
• Communicate with members, providers, internal departments, and other Blue Cross plans through telephone, fax, electronic, and written channels.
• Review submitted information for completeness and handle confidential records accurately.
• Complete reporting, research, unit testing, and user testing as needed.
• Support regulatory, URAC, quality, production, and service-level requirements.

Requirements

• Associate's degree, or an equivalent combination of education and experience.
• At least one year of experience in a healthcare-related field.
• Ability to multitask and navigate multiple systems.
• Residence in Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, or Texas is required for hybrid or remote work.
• Weekend rotation approximately every 4–6 weeks, including one hour on Saturday and one hour on Sunday.

Nice to have

• Bachelor's degree.
• Medical office experience.

Culture & Benefits

• Full-time position with hybrid or remote work options.
• Work supporting healthcare members, providers, and internal clinical operations.
• Environment focused on quality, compliance, service, and community impact.