Job Summary: The Medical Management Resolution Specialist (non-clinical staff) is responsible for monitoring the daily operations with the Medical Management Department, ensuring complete and accurate information is provided on all inquiries and deadlines are met per established departmental policy and procedures, state and federal requirements, and group health plan documents.

• Associates Degree or higher or equivalent work experience preferred.
• Detailed knowledge of CPT/HCPC, ICD-9/10 coding, and medical terminology preferred.
• Previous experience in Utilization/Medical Management within a Health Plan environment is preferred.
• Must be extremely organized, detail oriented, meet deadlines, and work well under pressure.
• Language Skills: Ability to effectively communicate in English, both verbally and in writing.
• Skills: Rudimentary familiarity with Centers for Medicare & Medicaid Services (CMS) guidelines.
• Bilingual, optional/preferred but not required.
• Empathetic, Caring, Compassionate Listener.
• Able to work with a diverse multicultural and socioeconomic population.
• Familiarity with health care delivery and/or health insurance programs.
• Ability to prioritize and multi-task.
• Strong problem-solving and critical thinking skills.
• Excellent computer skills. Proficient in M/S Office products, including Excel, Word, Access, PowerPoint, and Outlook.
• Knowledge of medical claim processing preferred.
• Utilization management experience with a various line of business preferred.
• Excellent written and verbal communication skills.
• Must be a team player and work autonomously.
• Must be innovative, take initiative, and exercise independent judgment and decision making.
• Ability to interpret and apply health plan benefits.
• Demonstrate the ability to identify, write, and/or implements new processes for better workflow.
• Ability to interpret and adhere to established department policy and procedure as well as all state and federal requirements as it relates to the Utilization Management process.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.