Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Utilization Management Specialist. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs. **Location:** ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. Contract Duration: 6+ Months **Required Skills & Experience** + High school diploma or GED + 3+ years of experience in related field. + Outbound call experience, or call center experience + Pharmacy experience as a Pharm tech or experience working in a pharmacy. **Desired Skills & Experience** + MHK experience + Healthcare background **What You Will Be Doing** •Conducts non clinical reviews based on applicable criteria and guidelines on requested services. Communicates decision to provider and/or member, according to department protocols. • Documents outcome of reviews and demonstrates the ability to interpret and analyze the non-clinical information. • Completes verbal or non verbal outreach to providers or members to obtain the medical information for the review. • Identifies and refers organization determinations that require a clinical review to a nurse or Medical Director. • Conducts reviews of authorizations entered to ensure accuracy to avoid impacting claims payment. • Supports the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards. • Supports the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing. • Serves as a subject matter expert for CM&O around the non-clinical review process. ******To be eligible to contract at this client you must be able to pass a drug test and criminal background check** **You will receive the following benefits:** + Medical Insurance - Four medical plans to choose from for you and your family + Dental & Orthodontia Benefits + Vision Benefits + Health Savings Account (HSA) + Health and Dependent Care Flexible Spending Accounts + Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance + Hospital Indemnity Insurance + 401(k) including match with pre and post-tax options + Paid Sick Time Leave + Legal and Identity Protection Plans + Pre-tax Commuter Benefit + 529 College Saver Plan Motion Recruitment Partners (MRP) is an Equal Opportunity Employer, including Veterans/Disability/Women. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance. **Posted by:** Andrew Chadwick **Specialization:** Medical / Healthcare Professional