Posted 112 months ago
Utilization Management Representative
AI Summary
Utilization Management Representative Kelly Services MAJOR DUTIES AND RESPONSIBILITIES • Responsible for coordinating cases for precertification and prior authorization review.• Manages incoming calls, including triage, opening of cases and authorizing sessions.• 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
About this role
Utilization Management Representative
Kelly Services
MAJOR DUTIES AND RESPONSIBILITIES
• Responsible for coordinating cases for precertification and prior authorization review.
• Manages incoming calls, including triage, opening of cases and authorizing sessions.
• 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.
Qualifications
EDUCATION/EXPERIENCE
• High school diploma or equivalent.
• Minimum of 2 years of customer service call-center experience is required.
• Experience in medical or insurance field strongly preferred.
• PC proficiency.
Additional Information
Pay Rate 16.75 per Hour