Job Description
About the position
- Responsibilities
- Intake information regarding the authorization of services for members.
- Communicate with case managers, PCPs, and members to promote quality service delivery.
- Monitor members' utilization patterns to identify high-risk cases and under/over use of services.
- Clarify benefits for providers.
- Requirements
- High school diploma or equivalent.
- Two years' experience in a medical practice office, urgent care, hospital, skilled nursing facility, or other healthcare setting, along with completion of a medical-related training program (e.g., Medical Assistant, EMT, Nursing Assistant).
- OR three years' experience in a medical practice office, urgent care, hospital, skilled nursing facility, or other healthcare setting.
- Nice-to-haves
- One year of 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.
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