What are the responsibilities and job description for the Utilization Review Case Management Assistant position at VIVA HEALTH?
VIVA HEALTH, ranked one of the Best Places to Work by Modern Healthcare, is seeking a Utilization Review Case Management Assistant to join our team in Birmingham, AL!
VIVA HEALTH is the first and only Alabama-based plan to be named an overall 5-out-of-5 Star Medicare Advantage Plan. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team!
The Utilization Review Case Management (URCM) Assistant will work alongside the URCM team to assist with incoming clinical requests and updates, hospital census reports, processing and distribution of authorization requests, and requesting clinical updates for members receiving acute and post-acute care. This role will manage notifying providers of denials, requests for peer-to-peer conversations and coordinating those conversations. This individual will interact with a variety of internal and external clients including physicians, providers, Case Managers and executives across the organization. This position requires a high level of interpersonal skills and will be available to assist with outgoing member and providers calls, data management and administrative support tasks as needed. This position will have work from home opportunities with some required occasional on-site work.
REQUIRED:
- High School Diploma or GED
- Minimum of one year experience in an office setting
- Good interview and telephone skills as well as the ability to work with external clients in a caring and helpful manner
- Ability to understand health care related service delivery system
- Ability to understand Microsoft Word and Excel; basic computer skills
- Excellent communication and relationship skills
- Organization and time management skills
- Ability to be flexible, adaptable and pivot to other tasks when needed
PREFERRED:
- Associate's degree in healthcare-related field such as practical nurse or medical technician
- Three or more years of experience in health care setting such as hospital, office, clinic, or other health care related setting
- Certification in health care related field such as LPN, coder, medical assistant, or technician
- Knowledge of basic medical terminology
