Utilization Management Rep.

posted:
Location
Newbury Park, California
Industry
Customer Service & Call Center (Office and Administrative Support Occupations)
Job Type
Temp to Perm
Working Hours
8:00 AM - 5:30 PM
Salary
US$ 18.00 per hour
Ref. Number
S_30721
Contact
Gaby Hernandez, Spherion
Phone
805-973-0955
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Job Description

Responsible for coordinating cases for pre-certification and prior authorization review.
Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient pre-certification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Responsibilities:
Responsible for coordinating cases for pre-certification and prior authorization review.
Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient pre-certification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Working hours: 8:00 AM - 5:30 PM

Skills:
HS Diploma or GED required
2 yrs. of customer service or call-center experience
Proficient with MS Word and Excel - Required
Medical terminology training and experience in medical or insurance field preferred

Education:
High School

Experience:
0-1 years

Qualifications:
HS Diploma or GED required
2 yrs. of customer service or call-center experience
Proficient with MS Word and Excel - Required
Medical terminology training and experience in medical or insurance field preferred

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

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