Utilization Management Specialist

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: TYPE OF WORK

Full Time

: SALARY

$5-$6

: HOURS PER WEEK

40

: DATE UPDATED

Feb 9, 2026

JOB OVERVIEW

About Us
We are a fast growing healthcare organization with MSO support for claims, provider payments, and capitation. Our Utilization Management (UM) team ensures accurate service review, compliant adjudication, and efficient payment workflows.

Key Responsibilities
- Review and adjudicate claims for accuracy, coding, and medical necessity
- Monitor utilization patterns, compliance, and high?risk codes
- Support audits, policy development, and clinical review
- Track capitation pools, analyze cost drivers, and prepare performance reports
- Manage provider payments: reconciliation, allocation, and reporting

Qualifications
- 2+ years in UM, billing, claims, or revenue cycle
- Strong knowledge of CPT, ICD-10, modifiers, and medical necessity
- Experience with MSO/IPA/payor or specialty practice preferred
- Familiarity with capitation models and financial analytics valued
- Detail-oriented, analytical, and strong communicator
- EHR/PM experience (NextGen, Epic, etc.) and Excel/Sheets proficiency preferred

For interested applicants, please send your cover letter and resume addressed to Dr. Yi Jiang at ---------- you!

SKILL REQUIREMENT

Medical Billing Revenue Cycle Management

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Utilization Management Specialist

Please login or register as jobseeker to apply for this job.

TYPE OF WORK

SALARY

HOURS PER WEEK

DATE UPDATED

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