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.
• Equipment is not provided.
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Full time located in our Wixom office.  Mon-Friday days. Great Benefits, PTO & Holiday! 401K! Employee Discounts and more!!

Apply today!