Utilization Management Assistant

Department:

11203 Wake Forest Baptist Medical Center - Utilization and Care Management

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Mon-Fri 8a-5p

Pay Range

$21.85 - $32.80

The Utilization Management Assistant provides essential administrative and operational support to the Utilization Management (UM) function within the Department of Care Coordination. This role works collaboratively with Care Coordination staff, Utilization Review nurses, Physician Advisors, medical center departments, and external payer partners to ensure timely, accurate exchange of clinical and authorization information. The ideal candidate thrives in a fast‑paced healthcare environment, demonstrates strong attention to detail, and consistently delivers excellent customer service while supporting patient care and regulatory compliance.

Essential Functions

• Manage incoming fax, phone, portal, mail, and other communication from internal and external customers related to clinical requests, authorizations, approvals, and denials
• Determine appropriate action for incoming requests and accurately document all activities in designated databases and areas of the Electronic Health Record (EHR)
• Communicate clinical needs, authorizations, and denials to Utilization Review (UR) nurses and UM leadership for follow‑up
• Relay information to third‑party payers on behalf of Case Managers via phone, fax, and electronic portals
• Proactively follow up with payers to validate authorizations, confirm approved days, and accurately capture approved days in the EHR
• Verify insurance information received via phone, fax, or portal and provide requested information to payers, including discharge dates, disposition, and clinical reviews or summaries prepared by UM RNs (as directed)
• Ensure all actions comply with confidentiality standards and HIPAA regulations
• Receive, track, and document insurance authorizations in the EHR
• Assist with audits related to Utilization Management and regulatory compliance
• Enter data into databases and spreadsheets and perform data tracking or analysis as directed
• Open, sort, and process incoming mail and correspondence directed to Utilization Review
• Maintain departmental records and files in accordance with policy
• Participate in the Utilization Management Committee by providing administrative and logistical support
• Interact with Physician Advisors following established escalation guidelines
• Provide efficient, courteous, and professional customer service to all internal and external callers
• Perform a variety of general office and administrative duties to support the UM function

Education, Experience, Licensure & Certification

• High school diploma required
• Associate’s degree in a health‑related field preferred
• Two (2) years of administrative or office experience, preferably in a healthcare setting preferred
• Proficiency with Microsoft Office applications required
• Licensure, Certification, or Registration: Not required

Skills & Qualifications

• Strong typing, data entry, and documentation skills
• Excellent interpersonal, communication, and customer service skills
• Ability to organize, prioritize, and manage multiple tasks simultaneously
• Ability to handle a high volume of phone calls and frequent interruptions
• Demonstrated attention to detail and commitment to accuracy and confidentiality

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adopt