Utilization Review Assistant

Portland, ME 04103

Employment Type: Full Time Industry: Office & Administrative Pay Rate: $21-$27.80 Specialty: Office Administrative Branch: Portland, ME Pay Type: Hour

Job Description

We are seeking a detail-oriented Associate Utilization Review Assistant to join our Utilization Management (UM) team. This role provides essential non-clinical support to ensure UM activities are completed accurately, efficiently, and in compliance with CMS, Tricare, and NCQA standards.

Temp role up to 6 months 

Key Responsibilities:

  • Support UM nurses, process authorization requests, and answer member/provider inquiries via phone (8 AM–4:30 PM).
  • Review, enter, and process authorization/organization determination (OD) requests per guidelines and standards.
  • Generate and send notifications to members/providers as required.
  • Manage daily notification and census queues.
  • Participate in team meetings and process improvement initiatives.
  • Perform other non-clinical duties as needed.

Job Requirements

  • Associate’s degree or equivalent experience.
  • 2+ years of managed care and call center experience.
  • Knowledge of CPT, ICD-10, and HCPCS coding is a plus.

Join our team and help us deliver exceptional healthcare support!

Additional Information

At HW Staffing Solutions we recognize the value of our employee associates as equally as our clients. We are passionate about people and improving the lives of every associate, we do this by connecting you with great companies and great opportunities. We celebrate our awesome diversity, believe that everyone has a unique talent, and appreciate the passion and perspectives that each of us bring to the table. Discover a new way to work together with a company that is focused on offering the best opportunities, benefits and career advancement in Accounting & Finance, Office & Administrative, Light Industrial, Professional & Technical, Call Center, Food Processing and Hospitality. HW Staffing Solutions is an Equal Employment Opportunity company.

Meet Your Recruiter

Sarah Gilliar
Staffing Specialist

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About Portland, ME

Discover exciting job opportunities in the vibrant Portland, Maine area! Known for its picturesque coastal charm, bustling Old Port district, and thriving arts scene, Portland is a city brimming with career possibilities and growth potential. From the renowned Portland Museum of Art to the eclectic array of seafood eateries along Commercial Street, there's no shortage of charm and culture to explore. Home to the Portland Symphony Orchestra, Portland Stage Company, and iconic Hadlock Field where fans cheer for the Portland Sea Dogs, this region offers a perfect blend of work and play. Dive into our job listings today and consider kickstarting your career in this enchanting city by the sea.