We are hiring a Utilization Management Rep II for the Maryland Behavioral Health Administrative Services Project. The job is a temporary position with a salary range of $17.00-$18.00 per hour. The position is remote and requires strong customer service and communication skills, as well as experience in a healthcare-related setting.
Requirements
- Managing incoming calls or incoming post services claims work
- Determines contract and benefit eligibility
- Provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Obtains intake (demographic) information from caller
- Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given
- Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care
- Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
- Verifies benefits and/or eligibility information
- May act as liaison between Medical Management and internal departments
- Responds to telephone and written inquiries from clients, providers and in-house departments
- Conducts clinical screening process
- Participate in developing department goals, objectives, and systems
- Participate in staff meetings and attend other meetings and seminars as assigned
- Recommend new approaches, policies, and procedures, to continually improve efficiency of the department and services performed
- Efficiently performs duties as assigned and works as a team within division and company
- Perform other related duties as assigned
Benefits
- 19 days of PTO
- 12 paid holidays, 13 paid holidays during election years
- Merit / COLA increases
- Flex time allowed, during the same week
- Medical, dental and vision insurance
- Medical and dependent flexible spending account
- Pet insurance
- Mass transportation benefit for the Maryland and Washington, D.C. area
- 401k with a generous employer match
- Easy to use employee self-serve HR portal
