PacificSource Health Plans · 1 day ago
Utilization Management Specialist (Monday-Friday)
Boise, ID
Full-time
Onsite
Mid Level
$45K/yr - $72K/yr
3+ years expPacificSource Health Plans is seeking a Utilization Management Specialist to facilitate workflow for specific utilization management activities and coordinate dental/medical authorization processes. The role involves ensuring member satisfaction and supporting department goals through effective communication and documentation.
CommunitiesCustomer ServiceNon Profit
Responsibilities
Review advanced level PA’s such as, but not limited to those pertaining to dental/medical, hysteroscopies, initial varicose vein treatments, laproscopies
Document pertinent information which supports recommended action plan
Make determinations based on approved criteria. Act as primary contact and coordinator of issues related to the dental/medical authorization process including member and provider communications
Provide telephone answering and customer service for the Health Services Department. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients
Serve as a liaison to PacificSource departments to facilitate provision of services and information
Enter and collate data; prepare reports as assigned. Participate in new staff orientation
Contribute to a positive work environment
Actively engage with identifying, developing, and executing department goals
Participate in team, department, company, and committee-related meetings as requested
Actively participate in quality improvement initiatives
Meet department and company performance and attendance expectations
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Perform other duties as assigned
Qualification
Required
Three to five years experience in health insurance industry or other medical setting
Thorough knowledge of utilization and case management, including preauthorization required
High school degree or equivalent required
Knowledge of health plan eligibility, benefits and medical interventions/management
Strong knowledge of medical terminology
Ability to work under time constraints
Proficient in Microsoft Office including Word and Excel
Knowledge of medical and dental terminology
Knowledge of CPT/ICD-9 coding
Knowledge of claims payment systems (e.g. Facets)
Knowledge of Medical management software (e.g. Dynamo)
Ability to prioritize responsibilities and to diplomatically handle demanding situations
Ability to work independently as well as be able to work effectively on a team
Preferred
Experience with medical/dental benefit coordination desired
Company
PacificSource Health Plans
Founded in 1933, PacificSource is a not-for-profit health insurer for people and organizations throughout the Northwest.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John Espinola MD MBA
President and CEO
Erick Doolen
Chief Operating Officer
Recent News
2025-11-29
2025-10-22
Company data provided by crunchbase