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Utilization Management Tech
Ref No.: 18-11507
Location: North Charleston, South Carolina
Start Date / End Date: 09/13/2018 to 11/01/2018
Rec ID: 8511106
Job Title: Utilization Management Tech
Location: North Charleston, SC 29405
Duration: 2 Months


Description:
  • 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.

Required Skills:
  • 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

Education:
High School Diploma / GED

Required Skills:
  • CLAIMS
  • DATA ENTRY
  • DATABASE
  • DOCUMENTATION
  • STAFF TRAINING

Additional Skills:
  • TRAINING
  • TRAINING PROGRAMS
  • WORD
  • CUSTOMER SERVICE
  • CUSTOMER SERVICE ORIENTED
  • DATABASES
  • MICROSOFT WORD
  • RETAIL SALES