Utilization Management Representative II/Clinical Liaison (Healthcare)

Location: Rocky Hill, Connecticut, United States. The role is virtually full-time, but requires in-person training and candidates must live within a reasonable commuting distance of the posting location unless legally accommodated.

Company

hirify.global is a Fortune 25 healthcare company focused on improving lives and simplifying healthcare.

What you will do

• Manage incoming calls and post-service claims work, including call triage and case opening.
• Determine contract and benefit eligibility and authorize inpatient admissions, outpatient precertification, prior authorization, and post-service requests.
• Collect demographic and clinical information from callers and providers using screening scripts.
• Search for providers, follow up on referrals, and coordinate specialty-care requests.
• Refer cases requiring clinical review to nurse reviewers and conduct clinical screening.
• Respond to client, provider, and internal-department inquiries while serving as a liaison with Medical Management.

Requirements

• High school diploma or equivalent.
• At least two years of customer-service experience in a healthcare-related setting, plus medical terminology training, or an equivalent combination of education and experience.
• Strong oral, written, and interpersonal communication skills.
• Problem-solving, facilitation, and analytical skills.
• Ability to attend required in-person training and live within reasonable commuting distance of the posting location.

Culture & Benefits

• Virtual full-time work with required in-person training and flexibility for eligible alternate locations within commuting distance of an office.
• Paid holidays, paid time off, and merit increases.
• Medical, dental, vision, short- and long-term disability, and life insurance benefits.
• 401(k) matching, employee stock purchase plan, wellness programs, financial education, and incentive bonus programs.
• Vaccination against COVID-19 and influenza may be required for certain patient- or member-facing roles, subject to applicable accommodations and laws.