Description

You will answer first-level calls in Utilization Review, evaluate certification requests, review medical records, coordinate with healthcare providers, and ensure patients receive appropriate, cost-effective care according to clinical guidelines and insurance requirements.

Requirements

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

Responsibilities

• Answer first-level calls in Utilization Review
• Evaluate certification requests by reviewing group-specific requirements
• Triage calls to determine if a Utilization Review Nurse is needed
• Review medical records
• Coordinate with healthcare providers to ensure appropriate, cost-effective care