This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2198713 Our Utilization
Management Rep will coordinate and manage incoming and outgoing
correspondence to include referrals, prior authorizations, provider
reconsiderations and other requests for service. Verify provider
contracting status and member eligibility to include any applicable
pre-existing period. Communicate and coordinate with providers to obtain
and verify information related to such requests.
We\'re looking for Utilization Management Rep with:
- 2 years\' relevant experience
What a day of a Utilization Management Rep would look like:
- Review\'s member eligibility and benefit structure for requested
referrals or prior authorizations.
- Responds to incoming calls from internal and external customers via
multiple types of media.
- Review documentation and requests additional information needed to
complete review of requested services.
- Initializes, routes, and complete, as appropriate, request for
services. Informs members and providers of determination.
- Enters and maintains documentation per policy and procedures.
- Completes correspondence according to established workflows.
- Performs other duties and responsibilities as assigned.
Additional skills that we are looking for:
- Good verbal and written communication skills
- Medical terminology
- Familiar with ICD10 and CPT coding
- Problem Solving
Reasonable accommodations
To perform this job successfully, an individual must be able to perform
each essential duty satisfactorily. The requirements listed above are
representative of the knowledge, skill and/or ability required.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against
any employee or applicant for employment because of race, color, sex,
age, national origin, religion, sexual orientation, gender identity,
status as a veteran, and basis of disability or any other federal, state
or local protected class.