Point32Health

UM Specialist

Canton, MA

Sponsorship not specified$25k-$37kDetected 12 days ago

CommunicationProblem Solving

About the role

Under the direction of the Precertification Team Manager, the UM Specialist is responsible for the daily management of non-clinical reviews supporting the clinical, business and program related work of the Utilization Management (UM) department.
The Specialist functions as a key member of the Utilization Management Team and department and is a representative of Point32Health's values to both the internal and external customer through written and verbal communication.
The UM Specialist is responsible for coordination of coverage determinations for special handling of designated products or accounts, all medical necessity denial letters and monitoring of daily processes performed by the coordinator.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Must be able to work under normal office conditions and work from home as required.
May be required to work additional hours beyond the standard work schedule.
They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.

Conducts staff audits and assists with managing monitoring tools to ensure quality of work by coordinators.
Excellent verbal and written communication skills.

Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.
The actual salary for this position will be determined by several factors, including the scope and complexity of the role
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay.
Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.
Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare.
Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone.
We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are.
3+ years of experience in a managed care/health industry environment experience

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background
it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions.
We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
Learn more about who we are at Point32Health.

This listing is sourced directly from Point32Health's careers page and normalized into a canonical job model.