Terms of Employment
• W2 Contract, 12 Months
• Remote Opportunity (Candidates must reside in the DMV)
Overview
The Utilization Management supports the clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care
Responsibilities
• 35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
• 35% Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
• 20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• 10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
Required Skills & Experience
• High School Diploma
• 3 years experience in health care claims/service areas or office support
• Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient
• Excellent communication, organizational and customer service skills
• Knowledge of basic medical terminology and concepts used in managed care.
• Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
• Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
• Ability to pay attention to the minute details of a project or task.
• Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.
Call center/phone experience, computer literate, reliability, communication skills and problem solving skills
Preferred Skills & Experience
• Two years’ experience in health care/managed care setting or previous work experience within division
• Knowledge of CPT and ICD-10 coding.
nTech is an equal opportunity employer. All offers of employment are contingent upon pre-employment drug and background screenings. Only candidates who meet all of the above client requirements will be contacted by a recruiter