Diabetes Utilization Management - CSR - Wixom

Apply Job Type Full-time Description Spring is here! Come grow with J&B's UM Team!! The Diabetes Utilization Management Team is comprised of Prior Authorization, Quality Assurance, and Provider/Vendor Services functions that work collaboratively to support timely and accurate access to diabetes therapies. Full time in our Wixom offices. Core Responsibilities Review and process requests for diabetes-related therapies, including CGMs, insulin pumps, and testing supplies Ensure accuracy and completeness of documentation to support timely order processing and authorization approvals Evaluate requests against payer guidelines, medical policies, and coverage criteria Communicate with leadership, provider offices, vendors, and patients to obtain required documentation and clarify orders Provide clear and professional written and verbal updates on order and documentation status Collaborate with clinical staff (nurses, pharmacists) for medical reviews and escalations Prioritize workload to meet turnaround time expectations and service level agreements Stay current on payer policy updates, diabetes technologies, and internal workflows Prior Authorizations Submit and track prior authorization requests with insurance providers Interpret and apply payer-specific requirements, including medical necessity criteria Identify and resolve authorization denials; initiate appeals and obtain supporting documentation as needed Follow through on pending authorizations to ensure timely determinations Maintain compliance with payer guidelines and internal quality standards Quality Assurance Perform quality reviews and participate in routine order and account audits Ensure accuracy across orders, documentation, and payer requirements prior to release Identify workflow or eligibility gaps and escalate trends for process improvement Take ownership of accounts requiring correction and ensure issues are fully resolved Provide feedback to team members and leadership to support ongoing quality improvement Provider / Vendor Services Serve as a liaison between internal teams, providers, vendors, and health plans to support continuity of care Conduct detailed account research using internal systems, payer portals, and direct outreach Identify, communicate, and resolve issues that may delay patient access to supplies Manage escalated or high-priority accounts with a sense of urgency and accountability Balance a high-volume workload while maintaining accuracy and attention to detail Coordinate with providers, manufacturers, and health plans as needed to resolve complex cases Participate in meetings or calls with external partners when required Assist with tracking and reporting of team metrics and trends Requirements Requirements Minimum of 2 year's DME experience and/or 2 years Utilization Management experience required (any combination) Proven high-quality customer service skills for internal and external customers. Excellent organizational skills and attention to detail. Ability to prioritize tasks and communicate effectively to groups. Proficient with Microsoft Office Suite - satisfactory completion of our skills testing is required. High school diploma or GED required. Full time located in our Wixom office. Mon-Friday days. Great Benefits, PTO & Holiday! 401K! Employee Discounts and more!! Apply today! Salary Description $18.00 hr