Description

You will handle first-level calls in Utilization Review, evaluate certification requests, triage calls to nurses when needed, review medical records, and coordinate with providers to ensure cost-effective care.

Requirements

• CNA, LPN, or Medical Assistant preferred
• Background in patient health support or care
• 1+ years of experience in this field
• Strong interpersonal and customer service skills
• Detail oriented with accuracy in reviewing pre-certifications

Responsibilities

• Answer first-level calls in Utilization Review
• Evaluate certification requests based on group specific requirements
• Triage calls to determine if a Utilization Review Nurse is needed
• Review medical records and coordinate with healthcare providers
• Ensure patients receive appropriate, cost-effective care per guidelines