Utilization Management Tech

Company: The Judge Group ( Learn More )

General Information
US-SC-North Charleston
Not Specified
Not Specified
Not Specified
Job Description Our client is currently seeking a Utilization Management Tech In Charleston, SC

This job will have the following responsibilities:
  • 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.

  • Qualifications & Requirements:
  • 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

  • If you are qualified and interested, please email your MOST UPDATED RESUME to [Click Here to Email Your Resumé] or call Zack at 484-270-1853
    Job Requirements