Facets with Pre-Auth
Introduction: This position involves working remotely and requires a minimum of 13 years of overall experience, with 7-10 years specifically in FACETS UM/Pre-Auth configuration. The ideal candidate will have expertise in TriZetto FACETS, UM/Utilization Management, Pre-Auth/Prior Authorization, US Healthcare Payer experience, UM workflows & clinical guidelines, state mandates, and strong documentation & communication skills.
Responsibilities:
Configure FACETS UM/Pre-Auth processes
Implement and maintain UM workflows and clinical guidelines
Ensure compliance with state mandates and regulations
Collaborate with stakeholders to optimize utilization management processes
Provide training and support to team members on FACETS Pre-Auth
Document all configuration changes and updates
Requirements:
Required Skills:
TriZetto FACETS expertise
UM/Utilization Management experience
Pre-Auth/Prior Authorization knowledge
US Healthcare Payer experience
Understanding of UM workflows and clinical guidelines
Familiarity with state mandates and regulations
Strong documentation and communication skills
Preferred Skills:
Experience with other healthcare management systems
Certifications in utilization management or healthcare administration
Experience with telemedicine or virtual care platforms
Looking for strong consultants with hands-on FACETS Pre-Auth experience.