The U.S. healthcare payer market is rapidly modernizing its authorization processes, and expertise in FACETS UM is in high demand. Companies are looking for consultants who can streamline pre‑authorization rules while staying compliant with ever‑changing state mandates. This role offers a chance to shape critical workflows for a national payer and work remotely from anywhere in the U.S.

Job Summary

We are seeking a seasoned FACETS UM Consultant to design, configure, and optimize pre‑authorization and utilization management rules within the FACETS (TriZetto) platform. You will collaborate with clinical, operations, product, and QA teams to ensure routing logic, benefit limits, and medical‑necessity criteria meet both internal standards and external regulations.

Top 3 Critical Skills Table

Interview Preparation

1. Explain how you would design a FACETS rule to enforce a benefit limit for a specific service.
   What the interviewer is looking for: Understanding of rule syntax, condition logic, and impact on claim adjudication.
2. Describe a scenario where state‑specific mandates conflicted with existing UM rules. How did you resolve it?
   What the interviewer is looking for: Ability to interpret regulations, stakeholder communication, and rule modification process.
3. Walk me through the end‑to‑end pre‑authorization workflow you have implemented, highlighting any automation you added.
   What the interviewer is looking for: Knowledge of routing, medical‑necessity checks, and use of FACETS automation features.
4. What metrics would you track to evaluate the effectiveness of a newly deployed UM rule set?
   What the interviewer is looking for: Insight into performance monitoring, KPI selection (e.g., turnaround time, denial rates), and continuous improvement.
5. How do you ensure that configuration changes do not introduce unintended side effects in other claim processes?
   What the interviewer is looking for: Testing strategy, QA collaboration, and change‑management best practices.

Resume Optimization

• FACETS (TriZetto)
• Prior Authorization
• Pre‑Auth
• Utilization Management (UM)
• Healthcare Payer Systems
• Rules Configuration
• Clinical Guidelines
• State Mandates Compliance
• Benefit Limits
• Medical Necessity Logic

Application Strategy

When reaching out to the recruiter, send a concise email that begins with a friendly greeting, attaches your latest resume, and clearly maps your experience to the role. Highlight your top two or three skills—such as FACETS rule configuration, prior‑authorization workflow design, and UM analytics—and reference any relevant projects where you delivered measurable improvements. Mention that you are excited about the remote flexibility and ready to contribute immediately.

Career Roadmap