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Utilization Management Intake Specialist

Remote:

Full Remote

Contract:

Fixed term

Work from:

China

Offer summary

Qualifications:

3+ years in a business environment., Experience in managed care/health industry., Strong writing and call center skills., Bachelor’s degree preferred..

Key responsabilities:

Coordinate medical necessity reviews.
Write and edit denial letters.

US Tech Solutions Large http://www.ustechsolutions.com

1001 - 5000 Employees

See all jobs

Job description

Job Title: Utilization Management Intake Coordinator
Location: Remote
Duration: 3-4 months contract (with possible extension)

Job Description :

Under the direction of the Precertification Team Manager the UM Specialist is responsible for the daily management of non-clinical reviews supporting the clinical, business and program related work of the department. The Specialist functions as a key member of the Utilization Management Team and department and is a representative of company’s values to both the internal and external customer through written and verbal communication. The Specialist is responsible for coordination of coverage determinations for special handling of designated products or accounts, all medical necessity denial letters and monitoring of daily processes performed by the coordinator.

Key Responsibilities/Essential Functions (in order of importance) ·

Coordinates and performs the review process for special groups as designated through company such as Local 26, USFHP.
Writes and edits all denial letters for medical necessity. ·
Participates in a structured training program for new staff. ·
Assists in training of existing new employees as new procedures and systems are introduced. ·
Conducts staff audits and assists with managing monitoring tools to ensure quality of work by coordinators
Assists partner departments to resolve claims discrepancies and resolve misdirected activity – exploring root causes and recommendations for resolution ·
Participates in advanced departmental operational and administrative processes such as requests for departmental information and follow up as requested ·
Participates in projects and special assignments for purposes of meeting timeliness and department compliance.
Required to represent the department on committees as requested

EXPERIENCE:

Three plus years of experience in a business environment required, managed care/health industry environment experience required.

SKILLS:

Evidence of strong writing skills. Call Center experience required.
Excellent verbal and written communication skills
Demonstrate proficiency and accuracy in performing data entry tasks in multiple applications.
Appropriately identify urgent situations and follow the established protocol.
Has the ability to manage multiple priorities as well as possesses the initiative and judgment to operate within a politically sensitive framework.
Exhibits initiative and is self-directed and self-motivated in work performance.
Strong organizational, problem solving, and conflict resolution skills and the attention to detail necessary to act within a complex environment.
Excellent interpersonal skills. (Position requires daily contact, by telephone, with network providers and their office staff, hospital contacts and company’s internal departments

EDUCATION:

Bachelor’s degree or equivalent relevant work experience is strongly preferred.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:

Fast paced office environment handling multiple demands. Must be able to exercise appropriate judgement as necessary. Work is done in an open cubicle office setting with other employees. Requires ability to sit for long periods of time performing data entry functions. May be required to work when the company is closed to meet business needs.

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
"US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran."