Utilization Review Representative, Care Management (Part Time, Non Benefitted)
Core
Process utilization review for inpatient and outpatient statuses, manage authorization requests with payors, and assist RN Care Managers with data collection and insurance verification.
Role type
Utilization Review Representative (Care Management)
Builds
Authorization approvals and care coordination for pediatric patients
Domain
Pediatric healthcare administration and insurance verification
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization review, insurance verification, data collection, financial counseling, conflict resolution, multi-tasking, independent judgment, third-party payer communication, Microsoft Office proficiency
Preferred skills
Pediatric nursing experience, CCS/Medi-Cal regulations knowledge, severity of illness criteria application, bilingualism
Technologies
Microsoft Office (Excel, Word, PowerPoint, Access)
Responsibilities
Process utilization review for inpatient and outpatient statuses, process internal and external authorization requests with payors, assist in completing RN Care Manager case loads, perform data collection and insurance verification, provide financial counseling and customer service
Seniority
Entry to Mid-level, hands-on IC