Job Opportunities in United States

Utilization Review Support Technician I-II
Position Purpose: To provide administrative support to the Utilization Review nurse/Managed Care Nurse and Director as well as maintaining files, data, and reporting mechanisms of the department.
Primary Functions:

• Responsible for compiling Precertification/UR Intake forms for the UR Specialist/Managed Care Nurse according to procedures, gathering faxed clinical, and forwarding to the UR Specialist/Managed Care Nurse

• Responsible for answering MC phones and logging calls in GBAS according to policy; and referring calls to customer service, or Pre-Determinations as needed.

• Responsible for attending renewal meetings, and maintain the Group Grid, and distributing monthly

• Responsible for timely input of Pre-Determination requests, approval, and denials, and communicating with Providers.

• Responsible for tracking Denials and appeals for Annual Denial reporting

• Responsible for providing direct technical support to the UR Specialist for the following duties:

o Assisting with scanning, and retrieving UM documents; and creating and tracking certified mail items.

• Responsible for daily generation of Precertification letters, and maintaining the UR Desktop accurately

• Responsible for UM File completion and readying files for digital scanning

• Completes other duties as assigned by the manager/supervisor within the scope and education of the individual

• Has the ability to:

o Get along with others
o Function as a team player
o Accept constructive criticism from the supervisor or manager
o Follows work rules and company policies
Controls: Independently performs all duties based on established procedure. Refers electronic problems and any other issues to the Administrative Coordinator or Director as needed.
Dimensions: Provides UR support to Managed Care nurses and the Director of Utilization Management for approximately 50,000 UR/CM lives.
Accountability: Works directly under the supervision of the Managed Care Administrative Coordinator and/or the Director of Utilization Management of IMS Managed Care, Inc.
Classified as a light job. No lifting normally included in job responsibilities
Heavy telephone support
Must sit for long periods of time with rest periods
Visual acuity required to use electronic equipment and read written information
Good hearing is required for telephone communications
Cognitive skills are required for reasoning and interpretation of information
Basic computer skills are required
Legible handwriting required for documentation
Must be able to communicate tactfully, diplomatically and effectively
Requirements: High school graduate with minimum 2 years experience in a clerical, secretarial or administrative assistant position; must have good written and oral skills; strong organizational, time management and decision making skills; prior ICD-10 and CPT Coding experience; ability to work with a minimum of direction; Excellent computer skills to include Word, Excel and Database experience.
Applicants without comparable experience and job history longevity will not be offered an interview.
Highly Desirable: Medical terminology and/or medical insurance experience.