Introduction
This position involves working remotely and requires a minimum of 13 years of overall experience, with 7-10 years specifically in FACETS UM/Pre-Auth configuration.
The ideal candidate will have expertise in TriZetto FACETS, UM/Utilization Management, Pre-Auth/Prior Authorization, US Healthcare Payer experience, UM workflows & clinical guidelines, state mandates, and strong documentation & communication skills.
Responsibilities
- Configure FACETS UM/Pre-Auth processes
- Implement and maintain UM workflows and clinical guidelines
- Ensure compliance with state mandates and regulations
- Collaborate with stakeholders to optimize utilization management processes
- Provide training and support to team members on FACETS Pre-Auth
- Document all configuration changes and updates
Requirements: Required Skills:
- TriZetto FACETS expertise
- UM/Utilization Management experience
- Pre-Auth/Prior Authorization knowledge
- US Healthcare Payer experience
- Understanding of UM workflows and clinical guidelines
- Familiarity with state mandates and regulations
- Strong documentation and communication skills
Preferred Skills
Experience with other healthcare management systems
Certifications in utilization management or healthcare administration
Experience with telemedicine or virtual care platforms
Looking for strong consultants with hands-on FACETS Pre-Auth experience.
Rate:
Not specified
Location:
Remote
IR35 Status:
Outside
Remote Status:
Remote
Industry:
Data & Analytics
Seniority Level:
Senior