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HealthCare Support

Job notes from the manager:  
Receiving requests and building the authorizations 
Forwarding it to the queue for reviewers 
Reach out to providers (in network-out of network) 
UR background, can be less than yrs of experience 
60% admin- 40% phone 
2 weeks of training on site 
 
 
Shift 8-5 Monday- Friday  
 
Interviews: with Daidra Williams (or team mates) 
 
MINIMUM QUALIFICATIONS: 
Bachelors Degree Required  
3 years of healthcare experience, looking for UR or prior authorization background, managed care preferred  
Microsoft Office (Word, Outlook, Excel) 
 
Job Description  
Under the direction of the Behavioral Health Program Manager, functions as a Utilization Management Coordinator in the Medical Affairs department. Primarily responsible for the initiation of cases by data entry of clinical, demographic and product information into the Medical Management system, via telephone, fax or online portal. Electronically routes cases to the nurse for review and decision. Handles data entry of all precertification of BH inpatient and outpatient service request. Responsible for accurate case completion /quality and productivity standards while staying within compliance timeframes. 
 
60% Data entry of requests for authorization for admissions, notification of behavioral health inpatient admissions and discharges services. Obtains all pertinent information and medical codes related to the admission, transfer, out of network provider, route of transport, type of service, type of durable medical equipment and other key information. 
10% Responds to outbound calls from providers. Forwards calls efficiently to other departments when appropriate. 
10% Assists in monitoring reports and refers to appropriate UM/CM Manager. 10% Maintains a current knowledge of Members with Special Healthcare Needs, and DSM V, AAPCA Members 
10% Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans. Other duties as assigned.

Provider Services

$20 - $22/hr

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