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Healthcare Facets UM (pre-Auth) Consultant

Remote • Posted 6 hours ago • Updated 32 minutes ago

Contract W2

Contract Corp To Corp

Remote

People Force Consulting Inc

Fitment

Dice Job Match Score™

🛠️ Calibrating flux capacitors...

Job Details

Skills

Healthcare
Facets
Pre- Auth

Summary

As an Facets with pre-Auth you will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards.

Responsibilities: -

A Facets UM Consultant is responsible for providing customers with application domain expertise related to Utilization Management rules and processes within the Facets platform. The consultant will analyze and review the existing Pre-Auth/UM rules configuration (both core and custom defined) and conduct requirements discovery sessions with clients to finalize outcomes, KPIs, and operational practices for the modified UM rules in adherence to State mandates
Review and analyze FACETS Pre-Auth/UM rules for state-specific customization.
Evaluate rule logic for authorization routing, benefit limits, and medical necessity guidelines.
Identify gaps affecting intake, determination, and UM workflows. Work closely with UM operations, clinical teams, and configuration groups.
5 - 8 years in UM/Pre-Auth configuration within FACETS.
Familiarity with UM workflows, clinical guidelines, and state mandates.
Experience working with clinical/utilization management stakeholders.
Deep understanding of US Healthcare payer operations.
Ability to analyze complex rules and configurations.

Experience: - 8+Years

Location: - Remote / PST work hours

Educational Qualifications: -

Engineering Degree BE/ME/BTech/MTech/BSc/MSc.

Technical certification in multiple technologies is desirable.

Mandatory skills - Trizetto Facets, Pre- Auth, Healthcare

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 90938791
Position Id: 2026-237
Posted 6 hours ago

Company Info

About People Force Consulting Inc

People Force Consulting Inc is an innovative and leading workforce solutions provider, providing Staffing and Professional Services to clients in USA and Canada. We empower our clients with the right work force. Our clients rely on us to provide services and solutions that leverage our industry and domain expertise combined with our technology prowess, delivery focus and quality.

We put our customer, employees and consultants at the heart of everything we do. Building enduring relationships with clients and candidates is our foundational principle. Our collaborative culture and work environment helps attract and retain exceptional talent which is a key ingredient to address our client s needs and help drive our sustained growth.

People Force Consulting Inc is a Certified Women s Business Enterprise (WBE). We strongly believe a diverse, inclusive environment allows customers and employees to reach their fullest potential.

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