Remote Utilization Management Pharmacist Jobs in Iowa

Job Description:

The Utilization Management department oversees delegated services for plans under managed care contracts. The Intake Coordinator in Utilization Management provides superior customer service by responding to inquiries related to pre-authorizations from members, providers, facilities, vendors, and internal departments. This role involves speaking with referral sources, collecting and entering information into the system, processing authorizations, and verifying insurance to ensure patients receive appropriate care from the correct departments or referral sources.
The Intake Coordinator also uses data and established processes to identify members who may benefit from Care Management services and takes appropriate action to initiate referrals. Additionally, this role serves as a trainer and mentor to new team members, supporting onboarding and providing ongoing guidance.

Schedule

This will be a hybrid position. Monday - Friday, 0900-1800

Essential Functions

• Provides telephone customer service by answering and returning calls promptly and courteously. Triages calls as appropriate and responds to requests accurately and in a timely manner. Complies with all information, privacy and confidentiality policies and regulations.
• Communicates with referral sources to gather and input intake information into the computer system, completing the intake process.
• Interfaces with third-party payers to determine insurance benefits or self-pay status at the time of intake, including reviewing EOBs, EOCs, and authorization lists.
• Establishes and maintains effective working relationships with both internal and external stakeholders.
• Assists in training new employees in account preparation and review functions, under the direction of a Lead or Level II team member.
• Expedites urgent cases, including those related to discharge planning, by collaborating with the appropriate discharge team members to gather required information.
• Obtains and verifies insurance eligibility and benefits using various phone and online resources. Translates narrative diagnoses from physicians or patients into appropriate ICD-10 and CPT codes.
• Adheres to regulated turnaround times for all service requests, including expedited handling of high priority cases. Organizes daily activities to ensure the departmental operations meet established standards.
• Escalates issues and concerns to Level II, Lead, or department leadership as applicable for prompt resolutions.

Skills

• Customer Service
• Computer Literacy
• Computer Systems/technology capable
• Telephone Communications
• Attention to Detail
• Data entry/typing
• Problem Solving

Minimum Qualifications

• Demonstrated customer service experience in healthcare setting.
• Knowledge of medical terminology or medical background.

Preferred Qualifications

• Bilingual in Spanish and English, with the ability to communicate effectively across both languages in a healthcare setting.
• One (1) year of work experience with Medicare, Medicaid, and commercial insurance plans, including preauthorization and utilization management.
• Proficient in CPT, HCPCS, and ICD-10 coding.

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing, and reading signs, traffic signals, and other vehicles.

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$19.50 - $26.48

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we usethe artificial intelligence ("AI") platform, HiredScore to improve your job application experience.HiredScore helps match your skills and experiences to the best jobs for you. WhileHiredScore assists in reviewing applications, all final decisions are made byIntermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.