As the Utilization Role Specialist, you are expected to oversee quality treatment to be offered by the medical people and group especially the doctors and nurses to their patients.

SCHEDULE: 8 AM – 5 PM Mountain Standard Time, follows Philippine Holidays

POSITION TYPE: Full Time

WORK ARRANGEMENT: Remote

ESSENTIAL FUNCTIONS

 >       Review and evaluate the insurance plans of clients and their patients

>       Provide recommendations to optimize plan utilization or to help secure treatment

>       Establish rapport with clients and their patients by providing support and showing compassion

>       Negotiate with insurance companies to secure treatments on the client's behalf

>       Monitor cases and follow through to completion

>       Submit reports on cases and perform other administrative tasks

QUALIFICATIONS

·       A Bachelor’s degree in the related field or commensurate experience

·       Behavioral Health Clinical experience is a plus

·       Experience or knowledge of the behavioral health industry a plus

·       Basic understanding of health insurance benefits, deductibles, and plan designs

·       Knowledge of the insurance treatment authorizations process

·       Proven history of results-driven performance

·       Proven track record of advancement due to performance

·       Ability to handle and work with confidential scenarios

·       Organized and detail-oriented, but flexible as things change

·       Have a steady hand (aka calm under pressure)

·       Resourceful with the ability to solve complex problems

·       Desire to fight for/advocate for others

·       Experience in a multi-client environment

·       Strong computer aptitude, which includes expertise with Microsoft 365 applications and Google

·       Strong organization, oral and written communication skills

·       Aptitude in data management, analytics, reporting preparation

·       Ability to function in an autonomous environment—independent worker, self-directed