Utilization Management Specialist id-1473

December 28, 2024

About Equip

Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower individuals to reach lasting recovery. All Equip patients receive a dedicated care team, including a therapist, dietitian, physician, and peer and family mentor. The company operates in all 50 states and is partnered with most major health insurance plans.

Founded in 2019 as a fully virtual company, Equip is built on the dedication of highly engaged, passionate, and diverse Equipsters who have shaped our unique culture. In recognition of this impact, Equip was honored in 2024 by Forbes as a Next Billion-Dollar Startup, LinkedIn as a Top Startup, TechCrunch as one of the 10 Most Exciting Digital Health Startups, Fast Company among the Most Innovative Companies, and Business Insider’s 44 Companies to Bet Your Career On. We are immensely grateful to our Equipsters for creating a sustainable company and treatment program that has served thousands of patients and families to date.

The Utilization Management Specialist will be responsible for obtaining timely authorizations from health plans, acting as a liaison between insurance companies, the Admissions team, and the Clinical team. The Utilization Management (UM) Specialist will manage both initial and ongoing insurance authorizations and operations, ensuring accurate treatment and authorization information is communicated to insurance companies and internal stakeholders.

Responsibilities

Develop collaborative relationships with insurance companies/payors to submit and track prior authorizations and concurrent reviews.
Synthesize large amounts of qualitative and quantitative clinical data into compelling authorization requests.
Escalate cases requiring peer review to the Utilization Manager.
Assist with appealing authorization denials.
Respond to inquiries from insurance companies and internal team members.
Work collaboratively with the Finance, Revenue Cycle, Admissions and Clinical departments.
Maintain confidentiality of patient care and business information.
Perform other duties as assigned.

Qualifications

3+ years of healthcare experience within utilization management, billing, insurance verification, or direct patient care.
Knowledge and experience with EMR systems.
Strong verbal and written communication skills.
Strong professional interpersonal skills with demonstrated ability to effectively collaborate with external and internal stakeholders.
Strong attention to detail with demonstrated ability to consistently follow processes.
Strong organizational and time management skills with a proven track record of meeting assigned deadlines and goals.
Familiarity with HIPAA privacy requirements for patient information. Ability to maintain and protect confidential information.
Excellent organizational awareness, adaptability, and conflict management skills.
A passion for living Equip’s mission and values.
Comfortable with ambiguity and ability to think critically to quickly and accurately work through challenges in a fast-paced, fluid environment.

Physical Demands

Work is performed 100% from home with no requirement to travel. This is a stationary position that requires the ability to operate standard office equipment and keyboards as well as to talk or hear by telephone. Sit or stand as needed.

Diversity, Equity, Inclusion, Belonging

At Equip, Diversity, Equity, Inclusion and Belonging (DEIB) are woven into everything we do. At the heart of Equip’s mission is a relentless dedication to making sure that everyone with an eating disorder has access to care that works regardless of race, gender, sexuality, ability, weight, socio-economic status, and any marginalized identity. We also strive toward our providers and corporate team reflecting that same dedication both in bringing in and retaining talented employees from all backgrounds and identities. We have an Equip DEIB council, Equip For All; also referred to as EFA. EFA at Equip aims to be a space driven by mutual respect, and thoughtful, effective communication strategy - enabling full participation of members who identify as marginalized or under-represented and allies, amplifying diverse voices, creating opportunities for advocacy and contributing to the advancement of diversity, equity, inclusion, and belonging at Equip.

As an equal opportunity employer, we provide equal opportunity in all aspects of employment, including recruiting, hiring, compensation, training and promotion, termination, and any other terms and conditions of employment without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, gender expression, familial status, age, disability, and/or any other legally protected classification protected by federal, state, or local law.

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Responsibilities

Qualifications