Compliance UMAC 3 (Wed-Sun)

Location: Remote nationwide within the United States; four-day, ten-hour schedule on either Wednesday–Saturday or Thursday–Sunday, with working hours between 8:00 a.m. and 8:00 p.m. Eastern Time. Occasional travel to hirify.global offices for training or meetings may be required.

Salary: $44,900–$60,200 per year

Company

hirify.global is a U.S. healthcare and insurance company serving Medicare, Medicaid, individual, family, military, and community members through hirify.global and CenterWell services.

What you will do

• Review utilization management activities and documentation for compliance with policies, procedures, and regulations.
• Collect and analyze daily, weekly, monthly, and ad hoc team and individual outcome metrics.
• Process QIO fast-track appeals and expedited authorization requests within regulatory turnaround times.
• Interpret guidelines and independently determine appropriate courses of action in varied and complex situations.
• Support operational objectives and contribute to continuous improvement of consumer experiences.

Requirements

• 1–3 years of technical experience and a clerical support background in a healthcare environment.
• Proficiency in Microsoft Word and Excel.
• Strong attention to detail, accuracy, and written and verbal communication skills.
• Ability to work independently under general instructions and within an agile team environment.
• Ability to work during EST operating hours and maintain a dedicated home office that protects member PHI and HIPAA information.
• High-speed DSL or cable internet with at least 25 Mbps download and 10 Mbps upload; satellite and wireless internet are not permitted.

Nice to have

• Utilization management experience in auditing, compliance, expedited requests, or QIO appeals.
• Associate or bachelor's degree in healthcare, business, finance, or a related field.
• Familiarity with medical terminology and ICD-10 codes.
• Current experience on the One Home / Home Solutions UM Team for 12 or more months.

Culture & Benefits

• Full-time employment with a 40-hour workweek and occasional overtime.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and additional wellness benefits.