The Utilization Review Assistant is responsible for the administrative components of Utilization Management that primarily focuses on supporting the medical review process.
Responsibilities
- Responsible for communication of required healthcare documents to patients and/or representatives.
- Adhere to regulatory and compliance standards
- Understanding benefits including Medicaid and Medicare
- Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs.
- Documentation entry
- Phone and Voicemail retrieval
- Mail distribution within the department
- Worklist management
- Other duties assigned
Education- H.S. Diploma - or GED - Required
Work Experience- Experience in healthcare, managed care, hospital, or clinical setting, or other comparable work experience. - Preferred
Licenses and CertificationsTravel Requirements- Travel to off-site locations may be required. - Required
Qualifications
Skills and AbilitiesEssential Technical/Motor Skills
- Hand/eye coordination: speaks clearly; good hearing, ability to use computers, printers and telephone equipment
- Interpersonal skills
- Ability to work as a member of a team and develop trusting relationships quickly
- Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities.
Interpersonal Skills
Essential Physical Requirements
Essential Mental Abilities
- Implements and provides ongoing support of members care plan, recognizes alternatives, identifying problems.
- Provides patient and family teaching about health related needs, financial needs and other coping issues.
- Concentrates on plans and roles of other team members, understanding all responsibilities and plans.
Essential Sensory Requirements
- Visual and hearing skills to obtain a driver’s license are required.
- Ability to communicate with members and families, communicating in person and on phone.
Exposure to Hazards
Other Skills and Abilities
- Must have access to transportation
