What are the responsibilities and job description for the Utilization Management Rep - Remote to Indiana position at Professional Management Enterprises?
Description
We are looking for a utilization management representative to join our team. This position is a remote role but you must live within 50 miles of Indianapolis, IN to be eligible. This role is Monday - Friday 8am- 5pm EST and the pay for this role is $18.50/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
- 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
Salary : $18 - $18
