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"Utilization Management Technician"

  • vTech Solution
  • North Charleston, SC, 29406

Posted on

Job Description:

Position Details:

Client : AmeriHealth

Job title : Utilization Management Tech

Location : 4390 Belle Oaks Drive, North Charleston, SC, 29405

Duration : 3 Months

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.

 

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

 

Skills and Experience:

Required Skills:

• Data entry

• documentation

• answering phones

• excellent multitasker

• medical terminology

 

Additional Skills:

• Database

• word

• customer service

• customer service oriented

• Microsoft word

 

Minimum Degree Required:

• Completed High School (Diploma or GED)


Company Description:

 vTech is a Managed IT Services firm based out of Washington DC with a primary focus on Cloud Computing and Professional Services. To know more about vTech Solution, please visit us on www.vtechsolution.com.

www.vtechsolution.com
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