- 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.
- Adheres to Select Health and KMHP policies and procedures.
- Supports and carries out the Select Health and Mercy Mission & Values.
- Customer service experience and interpersonal skills on phone and in-person
- Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs.
- Working knowledge of plan benefits and services
- Proven ability to keep accurate and timely records and documentation according to established processes
•High School Diploma / GED
Della Infotech Inc is in staffing business for five years. Over the years, we have placed hundreds of candidates to various temp and permanent positions with our 50+ happy clients all over US and Canada including Fortune 500 corporations.
Role: Utilization Management Technician 444*
Location: Baton Rouge,
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