Enloe Medical Center is hiring a Utilization Management Specialist to join our Utilization Management Department. This role is central to supporting our operations in utilization review, denials management, regulatory compliance, clinical documentation integrity, and transfer coordination. You’ll be responsible for establishing and maintaining an efficient work environment that enables the smooth operation of our department and contributes to our mission of elevating community health.

What You'll Do

Process and troubleshoot inpatient admission authorization and CCS referrals.
Compile and send appeals, and interface with payors on denials and appeal determinations.
Troubleshoot intricate and complicated payor issues forwarded from other departments.
Schedule peer to peer discussions.
Maintain essential tracking spreadsheets.
Provide administrative support including managing the main department phone line, payor requests, sick calls, tracking employee requirements, assisting with onboarding, attending meetings, supply ordering, and record keeping.
Create a cooperative impression throughout all interactions with internal and external customers.
Work independently to prioritize and manage multiple priorities.
Contribute to the service excellence mission of Enloe Medical Center.

What We're Looking For

Two years of experience working with computers (including databases and spreadsheets) OR an Associate degree or higher in a human service or health-related field OR two years of experience in a medical setting.
Working knowledge of medical terminology.
Proficient in Microsoft Word, Excel, and Internet access and use.
Skilled in the collection and analysis of data, and assessment of data integrity.
Ability to learn state and federal funding sources.
Analytical and grammatical skills necessary to communicate effectively, verbally and in writing.
Demonstrates strong skills in confidentiality, integrity, creativity, and initiative.
Demonstrates ability to interact with a wide variety of individuals and handle confidential/sensitive situations and information with tact and sensitivity.
Must be able to maintain strict confidentiality always.
Must be self-motivated, flexible, and detail oriented.
Must be able to fulfill the essential functions of the position.

Nice to Have

Previous experience in a case or utilization management setting.
Previous experience in medical back office, including insurance and billing.

Technical Stack

Microsoft Office
Databases
Spreadsheets

Team & Environment

You will be a member of the Utilization Management Department, collaborating closely with Patient Financial Services, HIM, Case Management, Quality, and other departments as needed. Our culture is built on Enloe's Planetree philosophy, valuing compassionate, person-centered care, human connection, and mutual support.

Benefits & Compensation

Compensation: $23.49 - $31.71 per hour.
$0 premium medical plan including vision insurance.
Prescription and dental group insurance.
Retirement plan with employer match.
Generous paid time off (PTO) plan that starts accruing immediately and can be used as it's earned.
Extended Sick Leave.
Flexible Spending Accounts for unreimbursed medical expenses and dependent care.
Employee Assistance Program.
Educational Assistance.