Utilization Management Specialist

Job overview

The Utilization Management Specialist role is described as remote, with the listing location in Canton, MA; pay is $25–$32 per hour. The role supports the Utilization Management department’s clinical, business, and operational functions under the direction of the Precertification Team Manager.

What you'll do

• Manage daily non-clinical review activities
• coordinate coverage determinations for designated products and accounts
• write and edit medical-necessity denial letters
• support training for new and existing staff
• audit coordinator work
• help resolve claims discrepancies and misdirected activities
• investigate operational issues
• support administrative requests and projects
• and communicate with providers, hospitals, provider-office staff, and internal departments.

What we're looking for

Skills & competencies

utilization management

healthcare operations

coverage determinations

medical necessity

denial letters

managed care

quality audits

provider communication

remote

canton ma

$25–$32/hr

us tech solutions

Work arrangement

• Weekend coverage required

Why this role

Six-month duration. Requires a bachelor’s degree or equivalent relevant work experience and at least three years of experience in managed care or the healthcare industry.

About the employer

US Tech Solutions, Inc. is hiring for this role. Industry: Temporary Help Services. Sector: 56.