Healthcare Utilization Review Specialist
Location
United States
Posted
8 hours ago
Salary
$22 - $24 / hour
Seniority
Senior
Job Description
Healthcare Utilization Review Specialist
Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA)
• Review claims in utilization review queues for medical necessity and authorization status; determine appropriate processing based on coding and plan language. • Support the daily operations of the Utilization Review department by assisting senior UR team members with case review activities. • Conduct outreach calls and collect data using established scripts, tools, and protocols, while maintaining productivity and service standards. • Process correspondence and faxes in accordance with timeliness standards; escalate to clinical team members when appropriate. • Perform clerical and administrative tasks, including scanning, document retrieval, and urgent claims processing support. • Communicate clearly, professionally, and courteously with internal and external stakeholders to resolve issues. • Provide written direction to other team members (nurses, claims auditors) to support accurate claims processing. • Maintain current knowledge of Standard Operating Procedures, member benefits, rights, and responsibilities. • Ensure compliance with BCBS Association standards and company policies. • Complete other related duties and projects as assigned.
Job Requirements
- Medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification.
- Fluent computer skills including MS Office (Word, Excel, and Outlook) and Internet applications.
- Strong reading comprehension
- Self-motivated, self-directed, operates without constant guidance.
- Must be able to make sound logical decisions and articulate the reasoning.
Benefits
- Fantastic medical, dental, and vision insurance*
- Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
- Company provided Basic Life and AD&D
- Company paid Short-Term and Long-Term Disability**
- Flexible Spending Accounts*
- 401(k) Retirement Plan with up to a 6% employer-match**
- WOW! (100% fully vested after 3 years)
- 10+ paid holidays
- Generous paid vacation and sick time
- Annual Volunteer Paid Day
- Annual Tuition Reimbursement
- Annual Health and Wellness Reimbursement
- Lots of fun company events
Related Guides
Related Categories
Related Job Pages
More General Jobs
Loss Control Representative
Pennsylvania Lumbermens Mutual Insurance CompanyAmerica's Oldest & Largest Mutual Insurance Company Dedicated to the Wood Products & Building Materials Industries
• Complete field surveys in accordance with departmental standards • Prepare technical reports on the risks surveyed • Assist the risk in preventing and/or reducing the loss potential • Manage time and territory to complete all assignments within established time frames
Development Officer
American Bird ConservancyWorking to conserve wild birds and their habitats throughout the Americas.
• Develop and implement fundraising strategies, in coordination with program and development directors, to meet or exceed programmatic annual and long-term fundraising goals • Identify, cultivate, solicit, and steward high-net-worth individuals • Research and pursue grant opportunities from private foundations and corporate entities, and lead on submission of proposals and reports • Coordinate donor communications, including updates on conservation impact, thank-you letters, and other personalized outreach • Coordinate donor recognition efforts and stewardship/cultivation activities to build long-term engagement • Uphold the highest level of grant stewardship • Ensure compliance with gift acceptance, reporting standards, and donor intent • Track fundraising progress and maintain accurate donor and prospect records in ABC’s CRM (EveryAction), and other grant tracking systems • Help develop and maintain program budgets in coordination with program, finance, and other development team members • Stay informed about trends in philanthropy, conservation funding, and donor engagement best practices • Provide input into conservation planning and project implementation • Assist with projects as requested
Administrative Officer
Global Partners DigitalWe’re working to enable a digital environment underpinned by human rights
• Help keep Global Partners Digital running smoothly in a varied, hands-on role • Coordinate logistics for high-profile international events • Manage social media presence • Support financial administration • Work closely with the COO and support GPD's projects, including the Freedom Online Coalition (FOC) Support Unit • Play an active role in fostering a positive, collaborative, and inclusive team culture
• Serve as primary clinical contact for patients throughout their episode of care, providing guidance and support from initial engagement through recovery and program graduation. • Respond to patient concerns or symptoms that arise outside of normal provider office hours. • Provide clinical triage and guidance, including: Self-care instructions, Urgent care referral, Escalation to on-call physicians or clinical teams • Offer reassurance and coaching to patients experiencing symptoms or uncertainty overnight • Conduct proactive outreach calls to monitor patient progress and ensure adherence to care plans. • Provide coaching, education, and support to patients and families navigating complex healthcare systems. • Act as a consistent point of contact to help patients avoid unnecessary emergency department visits or hospital readmissions. • Conduct structured post-discharge follow-up and monitoring to identify early signs of complications. • Ensure patients complete timely follow-up appointments with primary care providers and specialists. • Address medication adherence issues. • Escalate clinical concerns to physicians or care teams when early warning signs are identified. • Document all patient interactions, risk factors, and interventions within the care management platform. • Coordinate closely with physicians, discharge planners, case managers, and other healthcare providers to ensure continuity of care. • Facilitate access to services such as home health, rehabilitation, transportation, and durable medical equipment. • Connect patients with community resources and support services when needed.




