Detail of : Utilization Management Representative Job Opening in Houston
Do you want Career advancement? Job security? Work-Life Balance! Do you want to work for a very successful privately held company, 20 years in business with an excellent reputation! Required: LPN or Certified Behavioral Health Technician or Pharmacy Technician Certification or Certified Medical Assistant or other medical certification. ** Must have a strong background in comparing health plan policy to clinical review criteria to support physician review and ultimately case determinations.
Location: Remote due to COVID, then on-site headquarters in Portland, Oregon
WHY Relocate? The Greater Portland Area is quickly becoming one of America’s prime destinations, and it is easy to see why. If local to the area, the Pharmacy Utilization Management Assistant will discover an affordable cost-of-living, proximity to some of the country’s best schools, and a growing economy, making this region a great place to think about family. World-class cuisine, a legendary music scene, a nationally recognized craft beer and cocktail industry, and a long history of artistic culture will keep the city folks happy to the core. A short trip in any direction puts you square in the middle of the most beautiful nature the West Coast has to offer. From the snowy slopes of Mt. Hood, the rocky Oregon Coast, the outdoorsy type will find plenty to keep them happy.
This outstanding Healthcare Management Support organization is actively interviewing for a Utilization Management Assistant to join the Pharmacy UR / UM team. Join this established health management organization in the Portland area, and help support a huge group of stakeholders across the Western U.S.
The Company! Established over 20 years ago, this Medical Review Support organization offers comprehensive tools and services to a wide range of healthcare participants including independent physicians, medical groups, hospitals, ambulatory centers, clinic networks, health plans, and payers. Working with an outstanding team of Medical Review professionals, the Pharmacy Utilization Management Assistant will support efficient operations to many of these partners.
Reporting to the Utilization Review Operations Manager, the Pharmacy UM Assistant will play a central role in supporting efficient operations through the chart review and preparation of case summaries. Working closely with physician and nursing partners in writing, over the phone, and in virtual environments, the Utilization Management Assistant will directly support pre-authorization and appeals processes for medical treatments/procedures in more than 15 Pharmacy subspecialties.
This role will be based out of the company’s headquarters in Oregon and will require a regular physical presence at this organization’s office. While the role will begin remotely, once this company returns to the office, the Utilization Management Assistant will work in person from the beautiful office building downtown, with an amazing team of Utilization Process experts.
A key responsibility for the Pharmacy Utilization Management Assistant will be in ensuring the accuracy and timeliness of medical record review and case summary. This person will have a strong background in comparing health plan policy to clinical review criteria in order to support physician review and ultimately case determinations. In addition to strong Utilization Management and/or Utilization Review experience, this Assistant will also require Medial Certification as a Certified Pharmacy Technician (CphT), Certified Medical Assistant (CMA), Licensed Practical Nurse (LPN), or a Certified Behavioral Health Technician (CBHT). The UM Assistant will pay close attention to language and grammar, allowing for concise and clear communications across the company.
The Utilization Assistant will play a direct role in supporting Clinical Review operations for Pharmacy. This person will get to work with an expert team. For the dedication and hard work that this role will require, the Pharmacy Utilization Assistant will receive a generous benefits package, competitive compensation, work-life balance, and job security that comes with career advancement.
Job Type: Full-time
Pay: $65,000.00 - $80,000.00 per year
Employee assistance program
Flexible spending account
Paid time off
8 hour shift
Monday to Friday
medical record review and case summary: 3 years (Preferred)
comparing health plan policy to clinical review criteria: 3 years (Preferred)
Utilization review: 3 years (Preferred)
Utilization management: 3 years (Preferred)
excellent attention to language and grammar: 3 years (Preferred)
Medial Certification (Preferred)
Temporarily due to COVID-19
Remote interview process
If your qualification is matched with the requirement above, please submit your online application directly through Priviately-Held system at :
All applications will be treated confidentially.
Only short-listed candidates will be contacted.
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