Utilization Review Payer Specialist | Case Management | Days

Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks

Shift: Days

Pay Rate Type: Hourly

Location: Yuma Medical Center

Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates.

Min = $20.57

Mid = $25.71

Max = $30.85

Summary

Under the direction of the UR RN Manager, the Payer Specialist provides essential administrative and operational support to the Utilization Management (UM) team. This role helps ensure administrative utilization review processes run efficiently and accurately by managing incoming UM correspondence, tracking and entering payer authorizations, clinical review requests, and addresses denials, prepares and organizes clinical review packets, and facilitates timely communication between internal departments, external payers, and other stakeholders. The specialist prioritizes and manages multiple demands in a fast-paced environment while supporting UR nurses, physician advisors, and UM staff to promote appropriate utilization of healthcare resources, regulatory compliance, and timely reimbursement.

Responsibilities

Administrative & Clerical Support: Provides daily clerical and administrative support to the Utilization Management (UM) team. Manage, organize, and distribute incoming UM correspondence, including clinical requests, authorizations, and denial notifications. Responds to deliverables and stakeholder needs in a timely, effective, and appropriate manner, utilizing available resources to resolve issues and support departmental goals.

Data Management & Documentation: Accurately enter, update, and maintain patient data, payer responses, authorizations, and denial details in Epic and other UM systems. Manages new denials and enters important denial information into Epic. Prepare and assemble clinical review packets and supporting documentation for submission to payers and external partners. Assist with data collection efforts to support reporting, audits, and departmental initiatives.

Utilization Management Workflow Coordination: Monitor UM work queues and tasks to ensure reviews, submissions, and follow-ups are completed within required timeframes. Assist with coordinating peer-to-peer reviews and communicating outcomes to the UM team. Support UM nurses in resolving documentation or authorization issues that may delay patient care progression or reimbursement. Support the implementation of new processes, technologies, and departmental initiatives aimed at improving UM operations and overall efficiency.

Authorization, Denials & Payer Communication: Submit clinical documentation and authorization requests to payers through secure fax, portals, or phone in accordance with departmental workflows. Manage and distribute authorization and denial notifications. Support communication and follow-up activities with payers and external partners. Assist in identifying, tracking, and escalating authorization and denial issues as appropriate.

Quality, Compliance & Performance Improvement: Ensure documentation, submissions, and data entry activities are completed accurately and within established regulatory, payer, and organizational requirements. Support departmental workflows by maintaining organized records and timely processing of UM-related activities.

Collaboration & Customer Service: Establish effective working relationships with cross-functional teams, stakeholders, and client groups, cultivating strong professional rapport and collaboration. Contribute to a collaborative team environment by sharing information, supporting colleagues, and assisting with workload distribution as needed. Communicate professionally and effectively with internal and external customers to facilitate timely resolution of issues and support departmental goals. Foster positive working relationships that promote teamwork, operational excellence, and patient-centered outcomes.

Other duties as assigned

Other Information

Minimum Requirements

2+ years of experience

High School Equivalency Diploma

Fingerprint Clearance Card

Join us at Yuma Regional Medical Center dba Onvida Health

A career at Onvida Health is more than just a job. It’s a place to have a long and rewarding career, making a difference in the lives of those in our shared community. When you join our team, you become an integral part of a thriving community committed to improving the health and well-being of everyone in southwestern Arizona.

At Onvida Health, we believe in progress with purpose. Our commitment to innovation is matched by our dedication to kindness and integrity. We take our values seriously because we know they lead to better outcomes for our patients and a better experience for all of us. We’re looking for people who approach each day with a sense of possibility, a drive to make things better, and a commitment to kindness. If that sounds like you, you’re our kind of people.

If you’re looking for a career where innovation meets compassion, where you can grow and contribute to building a healthier tomorrow, Onvida Health is the place for you.

Life in Yuma, Arizona

Yuma, recognized by Guinness World Records as the Sunniest City on Earth, offers more than just sunshine. It’s a place where the great outdoors meets a welcoming, tight-knit community. Hike scenic trails, explore the Colorado River, or immerse yourself in local cultural festivals – all while embracing the beauty of this desert oasis. With easy access to larger cities and popular destinations, Yuma makes it easy to balance a fulfilling career with time for personal adventures and relaxation.

https://www.visityuma.com/

https://www.yumachamber.org/

Physical Requirements and working conditions for this position will be provided to you up on interview.