What are the responsibilities and job description for the Utilization Management Specialist 4-2026 position at PrimeWest Health?
As a Utilization Management Specialist, you’ll support the UM team by managing service authorizations, meeting strict regulatory standards, and keeping processes running smoothly—even during high-demand periods.
What You’ll Do:
- Process and file medical authorizations with precision.
- Communicate outcomes to providers and maintain accurate member records.
- Triage calls, handle mail, and manage documentation in the care management system.
- Assist with data entry, reporting, and creating graphs for annual UM reports.
- Coordinate urgent requests, pharmacy authorizations, and special projects.
- Ensure compliance with DHS, CMS & NCQA standards while meeting turnaround times.
Key Qualifications
- Education: High school diploma or equivalent required; post-secondary coursework in healthcare or business preferred.
- Experience: 1–2 years in healthcare administration, utilization management, or related field.
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Skills:
- Strong attention to detail and organizational skills.
- Ability to manage multiple priorities and meet deadlines.
- Proficiency with Microsoft Office and data entry systems.
- Excellent communication and customer service skills.
- Knowledge of: Healthcare terminology, regulatory requirements (DHS, CMS), and NCQA is a plus.
Why You’ll Love Working Here
- Medical Insurance
- Vision Materials Coverage
- Long-Term Disability (LTD) Coverage
- Life Insurance
- Pension Plan (PERA)
- 13 Paid Holidays
- Vacation Bank
- Sick Leave Bank
- Volunteer Time Off (VTO)
- Fitness Center Onsite
Make a real impact on healthcare quality while working in a collaborative, supportive environment.
Ready to join a team where accuracy and compassion matter? Apply today!