Position Summary
Responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case managers.
Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting.
Monitors members’ utilization patterns for identification of high-risk and under and over use of services. Clarifies benefits for providers.
This is a part-time position.
This is a fully remote position.
Required :
- High school diploma or equivalent.
- Two (2) years’ experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting and completion of a medical-related training program such as Medical Assistant, EMT or Nursing Assistant.
- Three (3) years’ experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting.
Preferred :
- One (1) year Managed Care Utilization review experience
- Experience and knowledge of the preauthorization process for medical services
- Physician office experience
- Experience and knowledge of Medicare, HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, claims processing, membership / eligibility)
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