Utilization Management Specialist

Remote Flex - North Carolinaremotemid$46K – $73K

Posted 5 days ago · via Workday

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About this role

Job Description We’re hiring a Utilization Management Specialist to join the Government Pharmacy UM Operations Team! The Utilization Management Specialist is responsible for the completion of non-clinical reviews and communication to customers to support utilization management reviews and activities. The Utilization Management Specialist may also provide support for administrative functions within the department to support turnaround times. What You’ll Do Conducts nonclinical reviews based on applicable criteria and guidelines on requested services. Communicates decision to provider and/or member, according to department protocols. Documents outcome of reviews and demonstrates the ability to interpret and analyze the non-clinical information.…

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