Utilization Management Specialist

Make an impact behind the scenes in healthcare by helping ensure members receive timely access to the medications and services they need. If you're detail-oriented, thrive in a high-volume environment, and have experience in utilization management, healthcare insurance, or pharmacy operations, this remote opportunity offers a chance to grow with a leading healthcare organization.

Location: Remote*
Pay Rate: $27-$30/hour
Employment Type: Contract
Schedule: Monday-Friday, 8:00 AM-5:00 PM

Why This Role Matters

As a Utilization Management Specialist, you'll play a key role in the authorization review process, helping ensure accurate and timely decisions while supporting providers, members, and internal care management teams. Your work will directly contribute to operational efficiency, regulatory compliance, and a positive healthcare experience for members.

What You'll Do

• Conduct non-clinical reviews of authorization requests using established criteria and guidelines
• Communicate review outcomes to providers and members according to department protocols
• Document review decisions accurately and analyze non-clinical information to support determinations
• Reach out to providers and members to obtain information needed to complete reviews
• Refer cases requiring clinical evaluation to nurses or Medical Directors
• Review authorizations for accuracy to help prevent claims payment issues
• Support care management activities by completing member and provider outreach to meet CMS requirements
• Process and route incoming faxed documentation to appropriate teams for review and action
• Serve as a subject matter expert on non-clinical utilization management processes
• Handle periodic inbound calls from Tier 1 support teams and assist with prior authorization activities

What We're Looking For

• A current, up-to-date resume
• High school diploma or GED
• 3+ years of experience in utilization management, healthcare insurance, retail pharmacy, or a related healthcare field
• Experience working in a high-volume, fast-paced environment
• Strong utilization management experience
• Exceptional attention to detail and documentation accuracy
• Ability to navigate multiple systems and portals while managing competing priorities
• Medicare experience preferred
• Retail Pharmacy Technician experience preferred
• Strong verbal and written communication skills
• Ability to meet compliance requirements
• Must be eligible and provide proof of eligibility to work in the US

What's In It For You

• Competitive pay rate of $27-$30/hour
• Fully remote work opportunity with preference for North Carolina candidates
• Structured training and onboarding program
• Opportunity to gain experience with a leading healthcare organization
• Collaborative team environment with ongoing quality and performance support
• Meaningful work supporting member care and access to healthcare services

Benefits for Manpower Associates (Upon Eligibility)

Upon completion of waiting period associates are eligible for:

• Medical and Prescription Drug Plans
• Dental Plan
• Supplemental Life Insurance
• Short Term Disability Insurance
• 401(k)

* Remote Eligibility: Remote workers must reside in one of the following states to be eligible for this remote opportunity: North Carolina, Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming