What are the responsibilities and job description for the Utilization Review Specialist position at Umpqua Health?
At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together.
Umpqua Health strongly encourages applications from candidates of color as well as veterans, aiming to foster a work environment that is linguistically and culturally diverse and inclusive. Please note that at this time, Umpqua Health does not offer visa sponsorship.
As a Utilization Review Specialist you will be responsible for ensuring that healthcare services are medically necessary, efficiently provided, and appropriately utilized. This role involves reviewing patient medical records, coordinating with healthcare providers, and ensuring compliance with regulatory and payer requirements.
Why Choose Umpqua Health?
Impactful Work: Make a difference in our community by helping members navigate their healthcare needs.
Supportive Environment: Join a collaborative team committed to your success and professional growth.
Comprehensive Benefits: Enjoy competitive pay, medical/dental/vision insurance, and opportunities for advancement.
Innovative Culture: Contribute to ongoing process improvements and technological advancements in healthcare service delivery.
- Performs data entry of authorization information (per policy/procedure) into web-based system as received through telephone calls, voice mail messages and emails.
- Gathers and organizes clinical information for review.
- Communicates authorization request status to the providers as per policy and procedure.
- Writes coverage determination letters.
- Works with computer/electronic medical records daily.
- Perform other duties as assigned by management to help drive our Vision, fulfill our Mission, and abide by our Organization’s Values.
- High School Diploma or equivalent.
- Demonstrate a proficiency in computer skills – Windows, Word, Excel, Outlook, clinical platforms, internet searches
- Knowledge of ICD 10 codes, CPT codes and medical terminology a bonus.
- Excellent organizational and communication skills.
- Ability to be flexible and work in a fast-paced office environment.
- Ability to prioritize a high volume of work.
- Medical office or hospital experience preferred but not required
- Excellent analytical and critical thinking skills.
- Strong communication and interpersonal skills, with the ability to work effectively with healthcare providers, patients, and insurance companies.
- Proficient in using electronic medical records (EMR) systems and utilization management software.
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
