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Utilization Management Technician

Company: ZolonTech
Location: Charleston
Posted on: September 13, 2019

Job Description:

Contract - 3 + months Position Summary: Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members. Facilitates the authorization process for requests that do not require clinical criteria application or judgment. Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available. Acts as a resource to staff for questions related to the prior authorization process. Refers unresolved prior authorization process questions to the Lead Intake Specialist. Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs. Identifies and reports member and provider educational opportunities to the Lead Intake Specialist. Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers. Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same. Supports Utilization Management nurses with data entry. Performs other duties as assigned. Key Competencies/Success Factors: Excellent interpersonal and verbal communication skills. Attention to detail and confidentiality. Patience and a balanced demeanor. Professional image. Ability to write clear and concise reports. Willingness to work any shift. Availability for in-service training.

Keywords: ZolonTech, Charleston , Utilization Management Technician, Professions , Charleston, South Carolina

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