Our client, a leader in the healthcare industry, is seeking a Utilization Management Specialist to join their team. As a Utilization Management Specialist, you will be part of the Care Management department supporting various teams. The ideal candidate will have excellent customer service skills, strong attention to detail, and the ability to de-escalate situations, which will align successfully in the organization.

Job Title: Utilization Management Specialist

Location: Durham, NC

Pay Range: $26.22 per hour

What's the Job?

• Conduct non-clinical reviews based on applicable criteria and guidelines on requested services.
• Communicate decisions to providers and/or members according to department protocols.
• Document outcomes of reviews and demonstrate the ability to interpret and analyze non-clinical information.
• Complete outreach to providers or members to obtain necessary medical information for reviews.
• Support the care management department by meeting CMS requirements for soliciting information or notification standards.

What's Needed?

• High school diploma or GED.
• 3+ years of experience in a related field.
• Familiarity with Microsoft Suite.
• Experience in the medical/healthcare industry is a plus.
• Knowledge of Nuxeo, Genesys, Care Radius, or Facets is a nice-to-have.

What's in it for me?

• Opportunity to work in a dynamic and supportive environment.
• Gain valuable experience in the healthcare industry.
• Engage in a role that allows for professional growth and development.
• Work with a team of dedicated professionals committed to excellence.
• Participate in a structured training program to ensure your success.

Upon completion of waiting period consultants are eligible for:

• Medical and Prescription Drug Plans
• Dental Plan
• Vision Plan
• Health Savings Account
• Health Flexible Spending Account
• Dependent Care Flexible Spending Account
• Supplemental Life Insurance
• Short Term and Long Term Disability Insurance
• Business Travel Insurance
• 401(k), Plus Match
• Weekly Pay

If this is a role that interests you and you'd like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you!

About ManpowerGroup, Parent Company of: Manpower, Experis, Talent Solutions, and Jefferson Wells

ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands - Manpower, Experis, Talent Solutions, and Jefferson Wells - creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2023 ManpowerGroup was named one of the World's Most Ethical Companies for the 14th year - all confirming our position as the brand of choice for in-demand talent.