Who we are:

Third Way Health (www.thirdway.health) helps medical practices and healthcare organizations across the United States to improve the patient experience while reducing the administrative burden on practice owners and management. We enable practices and healthcare organizations to enhance the experience of their patients by providing them with a leading technology platform and world class services. What unites us is our passion to support physicians and help patients from all backgrounds to have a better healthcare experience.

About the position:

We are seeking full-time Utilization Management agents to join our team in the Medellin area. As a valued member of our team, you'll play a crucial role in enhancing the healthcare experience for thousands of patients and providers in the US. In this role, you will perform prior authorization verification prior authorization and retrospective reviews for elective inpatient admissions, adhere to internal policies and procedures, perform any other job duties as requested. Weekend and holiday coverage may also be required based on business needs

Responsibilities:

• Conduct thorough prior authorization and retrospective reviews for elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment to ensure compliance and appropriate utilization.
• Make necessary calls as needed to ensure all parties are aligned throughout the process
• Assess and refer cases to Medical Directors when necessary, ensuring timely and accurate decision-making for complex cases.
• Stay updated on state and federal regulations, as well as accreditation standards, to ensure all processes meet required guidelines and industry standards.
• Follow internal policies and procedures diligently to maintain operational efficiency and uphold quality standards within the team.
• Undertake any other job-related responsibilities as assigned to support team objectives and contribute to overall operational success
• Accurately log cases in software platform to track and manage healthcare processes, AYCE and EZCAP, as necessary to ensure effective case handling and documentation.

Required skills and qualifications: 

• University or associate degree preferred
• Required knowledge in health insurance (at least 8 months)
• Strong communication, both written and verbal (candidates must be fluent in English and Spanish, C1 or above preferred)
• Expertise in healthcare (US healthcare sector experience; does not need to be a nurse or doctor) and managing call center operations
• Great active listening skills
• A patient and empathetic attitude
• Strong time management and organizational skills
• Adaptability and flexibility
• Comfortable working in fast-paced environments
• Excellent troubleshooting skills
• Computer literacy and proven track record of working in multiple systems in parallel
• Phone skills, including familiarity with complex or multi-line phone systems