Utilization Management Specialist (Healthcare)

Location: Remote Flex in the United States, with occasional in-office visits; candidates may work remotely from North Carolina and other states listed for the role.

Salary: $45,761–$73,217 per year.

Company

hirify.global provides health care coverage and delivery services with a focus on supporting its community.

What you will do

• Conduct non-clinical reviews of requested services using applicable criteria and guidelines.
• Communicate review decisions to providers and members according to department protocols.
• Document review outcomes and analyze non-clinical medical information.
• Contact providers and members to obtain information required for reviews.
• Refer organization determinations requiring clinical review to a nurse or Medical Director.
• Review authorization entries for accuracy and support care management and administrative teams with information retrieval, documentation, and CMS-related outreach.

Requirements

• High school diploma or GED.
• 3 or more years of experience in a related field.
• Ability to interpret and analyze non-clinical information.
• Knowledge of utilization management, medical review, clinical documentation, and health care regulations.
• Ability to work remotely in the United States and attend occasional in-office visits as required.

Nice to have

• Call center experience.
• Customer service experience in the healthcare or medical field.

Culture & Benefits

• Remote Flex work model with flexibility and occasional in-person collaboration.
• Medical, dental, and vision coverage.
• Health and wellness programs, parental leave, and adoption and surrogacy assistance.
• Career development programs and tuition reimbursement.
• 401(k) match with an annual company contribution and paid time off.