Job Description
We are seeking dedicated remote professionals residing in Florida to join our utilization management team. In this work-from-home role, you will play a critical part in connecting members with the care they need by processing member approvals and matching them with providers. You will enjoy a consistent Monday through Friday, 8:00 AM to 5:00 PM schedule. Our management team is deeply committed to your career advancement, providing a highly collaborative virtual environment with dedicated group chats to ensure you always have the support you need to succeed. Responsibilities Process member approvals and accurately match members with appropriate healthcare providers. Research and document essential medical information, including history and diagnosis, for clinical reviewers. Verify member insurance coverage, service eligibility, and benefit details using system tools. Ensure all authorization requests are addressed accurately and within contractual timelines to maintain performance metrics (95% audit success rate and under 2% error rate). Perform data entry to update and maintain authorization requests in the utilization management system. Maintain ongoing tracking of authorizations and referrals in accordance with compliance guidelines. Requirements & Skills High School diploma or GED required. 1 to 2 years of related experience in customer service, authorizations, and compliance. proficiency in Microsoft Office, specifically Excel (must be able to confidently navigate spreadsheets) and MS Teams. Must reside in the state of Florida for this 100% remote position. Preferred, but not required: Knowledge of medical terminology, general healthcare background, or experience with managed care systems.
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Process member approvals and accurately match members with appropriate healthcare providers.
Research and document essential medical information, including history and diagnosis, for clinical reviewers.
Verify member insurance coverage, service eligibility, and benefit details using system tools.
Ensure all authorization requests are addressed accurately and within contractual timelines to maintain performance metrics (95% audit success rate and under 2% error rate).
Perform data entry to update and maintain authorization requests in the utilization management system.
Maintain ongoing tracking of authorizations and referrals in accordance with compliance guidelines.
Skills
- Microsoft Experience
- Customer Service Experience
- Authorizations and Compliance
Qualifications
- Years of experience: 1 year
- Experience level: Experienced
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Work at office, Remote work, Monday to Friday, Shift work