Description

We are looking for a utilization management representative to join our team. This position is a remote role but you must live in Indiana to be eligible. This role is Monday - Friday 8am- 5pm EST and the pay for this role is $18.00/hr.

• Responsible for coordinating cases for precertification and prior authorization review
• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility
• Provides authorization for inpatient admission, outpatient certification, and post service requests
• Refers cases requiring clinical review to a nurse reviewer
• Responsible for the identification and data entry of referral requests into the UM system 
•  Responds to telephone and written inquiries from clients, providers and in-house departments
• Other duties as assigned

Requirements

Requires:

• HS Diploma/GED
• Minimum 1 year of customer service experience or call-center experience or any combination of education and experience
• Medical terminology training and experience in the medical or insurance field is preferred
• Needs to have strong oral, written and interpersonal communication skills, problem-solving skills, and analytical skills