Utilization Management Administrative Support

Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. The Utilization Management Administrative Support role is crucial in assisting various departmental functions. This position ensures that email requests from provider offices are handled promptly and efficiently.

Responsibilities include collecting missing information from offices necessary for claims processing and assisting in the creation of correspondence for providers and members. As well as including documentation to the requests for the clinical processors to make appropriate decisions. This role is integral in driving the workflow and efficiency of the entire department. The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on the authorization.

The UM department plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. They achieve this by utilizing clinical criteria and evidence-based guidelines to evaluate the necessity and appropriateness of treatments. In the Utilization Management Administrative Support role, detail matters and you will assist in data entry, and communication required by Utilization Management Department involving correspondence for enrollees and providers.

You will ensure that entry and manual creation of these ad hoc notifications are completed in a timely manner and meets federal, state, NCQA or contractual requirements.

• Self-Motivation & Organization:
  Must be self-motivated and highly organized with the ability to work autonomously without direct supervision.
• Flexible
  
  Hours:
  
  Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons.
• Deadline Adherence:
  Expected to meet established deadlines and deliver high-quality work consistently.
• Virtual
  
  Collaboration:
  
  Use virtual platforms like Teams and Microsoft Outlook for collaboration. Participate in regular monthly check-ins and bi-weekly department touch bases for market updates and team alignment.
• Confidentiality:
  Maintain strict confidentiality of information related to Avēsis and its customers, following our information security policies. This obligation continues even after employment ends, including secure handling of data and access management.

• Perform outreach to providers for correction and resubmission if a request is submitted with insufficient information.
• Create ad-hoc manual letter requests utilized to communicate with an enrollee and/or provider. These communications are time sensitive and must meet regulatory, accreditation or contractual requirements.
• Handle clerical support for the department, including but not limited to receipt and response of incoming and outgoing fax, email transmissions both internal and external, draft/upkeep meeting agendas, meeting minutes.
• Support UM leadership and Avēsis’ communication team in the review and routine maintenance of letter template library for accuracy.
• Light travel and delivery to local post office to ensure same day mailing for urgent mailings.
• Other duties as assigned.

• Ability to operate in a fast-paced environment under tight deadlines.
• Ability to multi-task.
• Handle outgoing correspondence, including emails, phone calls, and mail. Draft and proofread documents.
• Organize and maintain digital files and records, ensuring they are easily accessible and up to date.
• Assist with special projects and tasks as assigned, ensuring they are completed on time and to a high standard.

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
• Initiative: readiness to lead or take action to achieve goals.
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
• Flexible and responsive: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot complex issues, problem solve and…