Providing advanced operational expertise, the full-time Advanced Utilization Management Operations Specialist will support complex case resolution, oversee utilization management inventory, and drive issues through resolution while working remotely. Key responsibilities Serve as an escalation resource for complex authorization cases and investigate operational issues Support daily management of utilization management inventory, identifying and resolving discrepancies Conduct root cause analysis of operational errors and recommend corrective actions in collaboration with cross-functional teams Required qualifications High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration or related field preferred Minimum of 5 years of experience in utilization management, prior authorization, or healthcare operations preferred Strong knowledge of utilization management workflows and DMEPOS experience strongly preferred Experience with Medicare, Medicaid, and Commercial health plan requirements preferred Demonstrated ability to analyze complex operational issues and navigate multiple systems for case resolution