Inpatient UM Specialist in Boston, Massachusetts - #72565 | VanderHouwen

Description

Job Id: 72565

Inpatient UM Specialist
Our client is seeking an experienced Inpatient UM Specialist to support utilization management and prior authorization operations in a fully remote environment. This role is ideal for a healthcare professional who thrives in a fast-paced setting, excels at managing high volumes of requests, and is committed to delivering exceptional service to members, providers, and internal stakeholders. The successful candidate will play a critical role in ensuring timely authorization processing, maintaining regulatory compliance, and supporting effective healthcare delivery.

This role is fully remote.

Inpatient UM Specialist Responsibilities

• Review, prioritize, and process incoming authorization requests for inpatient, outpatient, and ancillary healthcare services.
• Evaluate requests for completeness, obtain missing clinical documentation, and ensure accurate submission routing according to established guidelines.
• Escalate cases requiring clinical review to appropriate healthcare professionals, supervisors, or medical leadership.
• Maintain productivity, quality, and turnaround-time standards while managing a high volume of authorization requests.
• Serve as a primary point of contact for providers and members, addressing inquiries related to authorization requirements, eligibility, benefits, and service coverage.
• Document interactions and authorization activities accurately within designated healthcare systems and databases.
• Communicate authorization determinations and status updates to providers in accordance with established procedures.
• Collaborate with clinical teams and cross-functional departments to resolve escalated issues and improve service delivery.
• Support departmental operations, including call triage, voicemail management, and workflow coordination.
• Promote understanding of utilization management processes and authorization requirements through professional provider engagement.

Inpatient UM Specialist Qualifications

• Associate degree in Healthcare, Social Work, Business, or a related field; equivalent combination of education and experience will be considered.
• Bachelor’s degree preferred.
• Three or more years of experience in healthcare administration, utilization management support, prior authorization, medical office operations, or a related healthcare environment.
• Experience working with healthcare management platforms, authorization systems, or payer databases such as Jiva, FACETS, or similar applications preferred.
• Knowledge of health plan operations, utilization management processes, member benefits, and provider services.
• Demonstrated ability to manage competing priorities and meet strict turnaround requirements in a high-volume environment.
• Strong customer service, problem-solving, and relationship-building skills.
• Excellent verbal and written communication skills with the ability to interact professionally with providers, members, and internal teams.
• High level of accuracy and attention to detail, with a commitment to maintaining data integrity and compliance standards.
• Proficiency with Microsoft Office applications and general computer systems.
• Ability to work independently in a fully remote setting while maintaining consistent attendance and performance expectations.

Compensation: (DOE)

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As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

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VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

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