Join the VitalCore Team in Massachusetts! We're people who are fueled by passion, not by profit.
VitalCore Health Strategies, (VCHS), an industry leader in Correctional Healthcare, has an opening for a Part‑Time (16 hours per week) Utilization Management Scheduler at the Regional Office in Hopkinton, MA.
Looking for a rewarding career in the field of healthcare? At VitalCore we pride ourselves on retaining and acquiring hardworking ethical individuals who are committed to providing quality services. Join our team and experience first‑hand how VitalCore Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff.
Holiday Pay: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day, and Christmas Day
Medical
Dental
Vision
Health Savings Account
Dependent Care Flexible Spending Account
Life Insurance
Short Term/Long Term Disability
Identity Theft Protection
Pet Insurance
Employee Assistance Program and Discount Center
401K & Plan Matching
PTO
Utilization Management Scheduler Position Summary
The Utilization Management Scheduler is responsible for case management for patients to advocate for optimum healthcare.
Responsible for accurate flow of medical information between patients, outside providers, and third‑party payers.
Researches and analyzes data for accuracy required for reimbursement.
Analyzes medical billing and identifies documentation deficiencies.
Uses established criteria to conduct preliminary decision review for services requiring prior authorization.
Assesses the need for additional information to complete a service decision request.
Works closely with UM team to expedite decisions that require clinical review and oversight.
Communicates results of reviews in UM program for the primary care team and clinical reviewers.
Handles all requests for review of authorization and data accuracy timely and efficiently.
Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual, and compliance requirements.
Maintain proficiency with technology such as Microsoft, Excel, and other platforms as required.
Maintain great customer service skills, including interpersonal conversation, patience, and empathy.
Problem‑solve and use critical thinking skills.
Maintain knowledge of CPT and ICD coding, as required. Provide flexibility and understanding of individualized care plans.
Work efficiently independently to make decisions and in a team, as needed.
Maintain security of patient information/adhere to HIPAA requirement.
Associate’s degree or equivalent experience – Bachelor’s degree preferred.
Has an active certification in Medical Coding.
10+ years professional work experience in healthcare, managed care, or insurance preferred.
Education, training, or experience as a medical coder, medical billing, or insurance coordinator required.
Must be fluent in English language, including reading, writing, speaking, and understanding.
Must be a supportive team member, who contributes to and demonstrates teamwork and team concept.
Able to make independent decisions when circumstances warrant such action.
Able to deal tactfully with personnel, family members, visitors, government agencies/personnel, and the general public.
VitalCore Health Strategies is an equal opportunity employer and is committed to creating and maintaining an inclusive workplace in which all employees have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives.
Keywords: Registered Nurse, Utilization, UM RN #indnc