Utilization Management Specialist

UMass Memorial Medical Center(1 month ago)

RemoteFull TimeMedior$83,116.8 - $149,593.6Utilization Management

About this role

The Utilization Management Specialist at UMass Memorial Health evaluates patient status against clinical criteria and payer requirements to determine the appropriate level of care. The role collects clinical data, completes audits, and generates reports to support utilization and reimbursement processes. The Specialist partners with clinical teams, physician advisors, revenue integrity, and payers to ensure accurate patient status, authorization, and documentation.

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Required Skills

Utilization Review
Case Management
Clinical Screening
Payer Relations
Data Collection
Report Generation
Denial Management
EMR
Clinical Assessment
Communication

Qualifications

Completion of an Accredited School of Nursing Program
Current Massachusetts RN Licensure and Registration
Bachelor of Science in Nursing (Preferred)

About UMass Memorial Medical Center

ummhealth.org

UMass Memorial Health is the largest health care system in Central Massachusetts offering the region’s most sophisticated medical technology & support services.

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