Must have "Utilization Management" experience.
within 30 miles range from Chattanooga, TN 37402 ( 30 miles distance should be within TN - out of the state won’t be considered )
Supports customer service activities and initiatives for a number of products or clients including but not limited to the Case Management and Utilization Management departments.
Responsibilities
o Screen incoming calls and / or faxes or other digital format for UM and / or CM and direct calls / faxes / other digital requests to the appropriate area.
Identify and refer cases appropriately to the Case Management and / or Transition of Care department.
o Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned.
o Load complete organization determination / notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines.
o Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, giving direction as necessary.
o Search for and key appropriate diagnosis and / or procedure code as part of the notification / prior authorization process.
o Must be able to pass required testing.
o Participation and attendance are mandatory.
o This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.
o Work overtime as required
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