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Utilization Management Tech
Ref No.: 18-20667
Location: Philadelphia, Pennsylvania
Job Title: Utilization Management Technician (Care Coordinator)
Duration:  Long Term Assignment
Location:  Philadelphia, PA
Principal Accountabilities: • Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members. • Facilitates the authorization process for requests that do not require clinical criteria application or judgment. • Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available. • Acts as a resource to staff for questions related to the prior authorization process. • Refers unresolved prior authorization process questions to the Lead Intake Specialist. • Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs. • Identifies and reports member and provider educational opportunities to the Lead Intake Specialist. • Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers. • Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same. • Supports Utilization Management nurses with data entry. • Performs other duties as assigned.
• Customer service experience and interpersonal skills on phone and in-person • Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs. • Working knowledge of plan benefits and services • Proven ability to keep accurate and timely records and documentation according to established processes
•High School Diploma / GED