Top 1016 Specialist benefits & compensation Jobs in Columbus

Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
- Weekends as needed
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid time off
- 401(k) matching
Quick Apply
Grants Specialist (2 Positions)
State of Ohio - Public Safety —Columbus, OH
- $31.47 an hour
- Weekends as needed
- Background check
- Mid-level
- Office
- Free parking
- Paid holidays
Quality Assurance Specialist
Klarna Bank AB —Columbus, OH
- $75,281 - $84,315 a year
- Full-time
- English
- Finance
- Analysis skills
- Health insurance
- Dental insurance
4d
Quality Assurance Specialist
Hims & Hers —New Albany, OH
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
- Employee stock purchase plan
- Health insurance
6d
Utility Specialist 3
State of Ohio - Public Utilities Commission —Columbus, OH
- $41.81 an hour
- Full-time
- Mid-level
- Office
- 3 years
- Paid holidays
- Health insurance
20h
Accessibility Compliance Support Analyst - Intermittent (Software Development Specialist 1)
State of Ohio - Medicaid —Columbus, OH
- $34.53 an hour
- Part-time
- Computer Science
- Research
- Mid-level
- Paid holidays
- Health insurance
14d
Software Development Specialist 4 (2 positions)
State of Ohio - Public Safety —Columbus, OH
- $46 an hour
- Multiple hires
- Background check
- Computer Science
- Pass drug screening
- Free parking
- Paid holidays
4d
Software Development Specialist 3 (5 positions)
State of Ohio - Public Safety —Columbus, OH
- $41.81 an hour
- Multiple hires
- Background check
- Computer Science
- Pass drug screening
- Free parking
- Paid holidays
4d
Document Control Specialist II
HNTB Corporation —Columbus, OH
- $66,406.79 - $99,610.19 a year
- Full-time
- Mid-level
- Office
- 3 years
Middleware Analyst (Infrastructure Specialist 1)
State of Ohio - Medicaid —Columbus, OH
- $34.53 - $50.66 an hour
- Overtime
- Computer Science
- Mid-level
- Driver's License
- Paid holidays
- Health insurance
7d
Case Records Specialist
NATIONAL YOUTH ADVOCATE PROGRAM —Columbus, OH
- $20 an hour
- Online Application
- Clean driving record
- Word processing
- Office
- Paid holidays
- Health insurance
Quick Apply
Database Administration Specialist 1 - PN 20064762
State of Ohio - Industrial Commission —Columbus, OH
- $34.53 an hour
- Full-time
- Background check
- Computer Science
- Computer literacy
- Paid holidays
- Health insurance
8d
Quality Improvement Specialist
Sevita —Columbus, OH
- $45,000 a year
- Full-time
- Customer service
- Mid-level
- Residential
- Paid holidays
- Paid time off
5d
Post Closing Specialist
Empora Title —Columbus, OH
- Full-time
- Computer literacy
- Office
- Computer skills
- Paid parental leave
- Disability insurance
Customer Experience Specialist - Emergency Departments
OhioHealth —Columbus, OH
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
Specialist, Quality (Systems and Data)
The Scotts Miracle-Gro Company —Marysville, OH
- $59,700 - $70,200 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Product management
- Health insurance
- Dental insurance
AML/ KYC Specialist
Klarna Bank AB —Columbus, OH
- $62,938 - $86,844 a year
- Full-time
- English
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
4d
Quality Assurance Specialist - Complaints
BI Pharmaceuticals, Inc. —Columbus, OH
- Full-time
- Hybrid work
- Microsoft Word
- 7 years
- Microsoft Excel
Financial Crime Compliance Specialist
Klarna Bank AB —Columbus, OH
- $105,394 - $132,206 a year
- Full-time
- English
- Analysis skills
- Senior level
- Health insurance
- Dental insurance
4d
Database Administration Specialist 3
State of Ohio - Insurance —Columbus, OH
- $46 an hour
- Online Application
- Background check
- Computer Science
- System design
- Paid holidays
- Health insurance

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Utilization Management Specialist

ST VINCENT FAMILY SERVICES
Columbus, OH

Quick Apply

Job Details

Full-time

Benefits

Paid time off
401(k) matching

Qualifications

Associate's degree

Full Job Description

At St. Vincent Family Services, it's our job to help families build bright futures. Make it your job, too!

We offer competitive compensation based on education, experience, licensure, and internal equity, along with comprehensive benefits, 401(k) matching, and a generous PTO package.

These are just a few of the many reasons to join our team.

SUMMARY

The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations (MCOs). This position serves as the primary liaison between St. Vincent Family Services and MCO payors to ensure authorization requests are submitted timely, approved services are tracked accurately, and service disruptions are prevented.

The Utilization Management Specialist monitors client eligibility, tracks authorized units by procedure code, manages authorization renewals, and communicates authorization approvals and denials to treatment teams. This role works closely with clinical staff, program leadership, billing, and MCO representatives to maximize reimbursement, ensure compliance with payer requirements, and support continuity of care for clients.

ESSENTIAL DUTIES & RESPONSIBILITIES

Maintains confidentiality and compliance with HIPAA, agency policies, and payer regulations.
Serves as the primary point of contact for all MCO prior authorization activities.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals, denials, and requests for additional information.
Verifies and documents client eligibility and insurance coverage prior to authorization submission and throughout treatment episodes.
Runs authorization utilization reports and analyzes data to identify clients approaching authorization thresholds.
Maintains an authorization tracking system that includes:
- Authorization numbers
- Approved dates of service
- Procedure codes
- Authorized units
- Units utilized
- Remaining units
- Expiration dates
Monitors service utilization and proactively identify clients nearing authorized unit limits.
Requests completed clinical documentation and authorization forms from treatment providers when renewal thresholds are met.
Reviews authorization packets for completeness and accuracy prior to MCO submission.
Submits initial, concurrent, and reauthorization requests to Medicaid Managed Care Organizations within required timelines.
Coordinates responses to MCO requests for additional documentation or clinical information.
Communicates authorization approvals, denials, partial approvals, and service changes to treatment team members in a timely manner.
Collaborates with program directors, treatment providers, and billing staff to resolve authorization concerns and prevent service interruptions.
Maintains organized electronic records of all authorization submissions, determinations, and correspondence.
Tracks authorization denial patterns and communicates trends to leadership.
Assists with audits, quality assurance activities, and compliance reviews related to authorization management.
Develops and maintains productive working relationships with MCO representatives.
Participates in department meetings, training, and process improvement initiatives.
Performs other duties as assigned.

QUALIFICATIONS

Education and/or Experience:

Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Minimum of two years of experience in healthcare authorization management, utilization management, medical billing, behavioral health administration, or related healthcare setting preferred.

Knowledge, Skills & Abilities:

Strong understanding of behavioral health authorization processes and payer requirements.
Knowledge of Medicaid and Managed Care authorization procedures preferred.
Excellent organizational skills and attention to detail.
Strong analytical skills and ability to interpret utilization and authorization reports.
Ability to manage multiple deadlines and competing priorities.
Ability to communicate effectively with clinical, administrative, and payer representatives.
Ability to maintain accurate records and follow complex payer requirements.
Ability to work independently while functioning as part of a collaborative team.

Technical Skills

Proficiency in Microsoft Outlook, Excel, Word, and Teams.
Ability to learn and navigate multiple MCO portals.
Experience with electronic health records and data management systems.
Ability to generate, analyze, and maintain utilization tracking reports.

WORK ENVIRONMENT

Standard office environment with occasional evenings/weekends for events. Hybrid schedule available after 90-day probationary period.

Requires prolonged sitting and extensive computer use.
Requires manual dexterity sufficient to operate a computer, telephone, and other office equipment.
Requires normal range of hearing and vision to prepare reports and communicate effectively.
May occasionally lift and/or move items up to 15 pounds.

Quick Apply

Refine Your Search

specialist benefits & compensation jobs in columbus

Utilization Management Specialist

Grants Specialist (2 Positions)

Quality Assurance Specialist

Quality Assurance Specialist

Utility Specialist 3

Accessibility Compliance Support Analyst - Intermittent (Software Development Specialist 1)

Software Development Specialist 4 (2 positions)

Software Development Specialist 3 (5 positions)

Document Control Specialist II

Middleware Analyst (Infrastructure Specialist 1)

Case Records Specialist

Database Administration Specialist 1 - PN 20064762

Quality Improvement Specialist

Post Closing Specialist

Customer Experience Specialist - Emergency Departments

Specialist, Quality (Systems and Data)

AML/ KYC Specialist

Quality Assurance Specialist - Complaints

Financial Crime Compliance Specialist

Database Administration Specialist 3

I want to receive the latest job alert for specialist benefits & compensation in columbus

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