Job Description:

Provides superior customer service to all inquiries and questions regarding preauthorization for members, providers, facilities, vendors, other departments and teams. Uses data and process to identify members in need of Care Management and takes the appropriate action to engage the member in our Care Management program. 50% of this work responsibility will be making outbound calls

This position is a Hybrid role and will work a 9:30am- 6pm schedule with the expectation to be on site once a week as well as working one weekend per month.

Job Essentials

1. Participates in the identification, development, and implementation of new programs or process improvement initiatives by taking an active role or leading department project teams.
2. Receives incoming calls from members, providers, facilities, vendors, and other departments while providing professional solutions and information for situations and problems. Follows established guidelines to complete pre-authorizations for members and providers.
3. Supports the care management program over multiple disciplines by calling members and offering information/resources or engagement in Care Management, starting cases and tasking cases to the Care Manager.
4. Makes outbound calls as needed to obtain information for compliance with NCQA, CMS or other regulatory guidelines for completion of utilization review preauthorization service requests or concurrent reviews in a timely manner

5. Notifies requesting providers of review outcome.

6. Indexes and distributes inbound requests from AWD and other documentation systems to appropriate team members in a timely fashion. Indexes and distributes cases to medical reviewers.

7. Completes report assignments in designated time frames. Reviews inpatient facility census and makes referrals to Care Manager as appropriate .

Minimum Qualifications

Experience in medical office/insurance, or health related customer service experience; experience must include taking incoming or making outgoing telephone calls in a professional environment.

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Demonstrated basic computer skills

Preferred Qualifications

Knowledge of medical terminology or medical background.
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Ability to work independently, demonstrates flexibility, and be self-motivated with a positive attitude.

Physical Requirements:

Interact with others requiring the employee to communicate information.
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Operate computers and other office equipment requiring the ability to move fingers and hands.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$18.89 - $28.76

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package and our commitment to diversity, equity, and inclusion .