Utilization Management Assistant
Core
First-level caller for utilization review, evaluating certification requests and triaging calls to determine if a Utilization Review Nurse is needed.
Role type
Utilization Management Assistant (Healthcare Operations)
Builds
Utilization review processes for Health & Wellness participants
Domain
Healthcare / Insurance Utilization Management
Deliverable
client delivery
Required skills
Medical records review, coordination with healthcare providers, insurance requirements knowledge, clinical guidelines adherence, call triage, pre-certification review
Preferred skills
CNA, LPN, or Medical Assistant certification, patient health support background, customer service experience
Responsibilities
Answer first-level calls for utilization review, evaluate certification requests against group requirements, triage calls to determine need for Utilization Review Nurse, review medical records, coordinate with healthcare providers
Seniority
Entry-level to Junior, hands-on IC