Utilization Management Intake Specialist

Job Summary: We are seeking a dedicated individual to handle all inbound inquiries related to utilization management from providers and pharmacies. In this role, you will evaluate requests, verify member benefit coverage, and create cases in Highmark's Utilization Management system for clinical review. Your attention to detail is crucial to ensure compliance with regulatory standards and service agreements. Communications may occur via fax, provider portal, or inquiry forms, and you may need to follow up with healthcare providers as necessary. Essential Responsibilities: Receive provider or pharmacy requests through various channels, including fax and provider portal. Occasionally, requests may come via phone. Utilize multiple software systems to confirm member eligibility and gather necessary documentation. Assess cases requiring additional notifications to members or providers, and if needed, reach out for more information. Ensure the accuracy of data entry to prevent compliance issues and streamline downstream processes. Perform additional duties as assigned. Experience: 1 year of Customer Service experience. 1 year in the Healthcare Industry. Skills: Strong written and verbal communication abilities. Competency in navigating multiple systems simultaneously. Familiarity with administrative and clerical tasks such as word processing and file management. Strong interpersonal skills to interact effectively with colleagues and clients. Problem-solving aptitude. Understanding of customer service principles and standards. Education: High School diploma or GED required. Licenses or Certifications: No specific licenses or certifications required. Travel Requirement: Limited travel required (0% - 25%). Environment and Working Conditions: This is an office-based or remote position. May occasionally involve training others. Some rare travel from the office to various work sites may be required. No physical labor related to site sales tasks. Constant lifting of up to 10 pounds, occasional lifting of 10 to 25 pounds, and rare lifting of 25 to 50 pounds. Pay Range: Starts at $19.27 and can go up to $26.88 per hour, depending on qualifications and experience. At Highmark Health, we are committed to ensuring equal employment opportunities for all individuals regardless of protected statuses. We also strive to provide an accessible application process for all candidates.

Created: 2026-03-04