Utilization Management Specialist

Role Overview

• Obtaining initial and subsequent authorizations of clinical services from insurance and government payors
• Reviewing clinical records and determining the appropriateness of patient admission, level of care, continued length of stay, and discharge
• Providing training and support to clinical treatment staff on the insurance authorization process
• Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures
• Preparing regular summary reports and presentations on utilization management data
• Other duties as assigned

Requirements

• Bachelor's degree in counseling, nursing or a closely related field.
• 1+ years of experience with the utilization management process in a healthcare setting

Benefits

• Medical, dental, and vision insurance for employees and dependents
• Employee wellness program promoting health and fitness and offering cash-saving premiums
• Employee assistance programs focused on mental health
• 403(b) Retirement Plan with 3% employer match
• Short-term and Long-term Disability and Life and AD&D Insurance paid for by Gateway
• Flexible Spending Accounts for medical and dependent care
• Public Service Loan Forgiveness (PSLF)
• 18 paid time off days per year – accrual rates increase with years of service
• 9 paid company holidays
• Training & Development Programs
• Tuition Reimbursement
• up to $5,250 per calendar year
• eLearning access to online courses that provide CEU’s and job-related training
• Formal and informal guidance