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Utilization Mgmt Tech
Ref No.: 17-07892
Location: North Charleston, South Carolina
Start Date / End Date: 10/09/2017 to 11/17/2017
Utilization Mgmt Tech

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.
• Adheres to Select Health and KMHP policies and procedures.
• Supports and carries out the Select Health and Mercy Mission & Values.
Key Competencies/Success Factors:

• Excellent interpersonal and verbal communication skills.
• Attention to detail and confidentiality.
• Patience and a balanced demeanor.
• Professional image.
• Ability to write clear and concise reports.
• Willingness to work any shift.
• Availability for in-service training.