McLaren Health Care-posted about 1 year ago
Full-time
Remote • Indianapolis, IN
Nursing and Residential Care Facilities

The Intake Specialist is responsible for the intake of information regarding the authorization of services for members across all product lines. This role involves communication with case managers, primary care providers (PCPs), and members to ensure the delivery of quality services in a cost-effective manner. The specialist monitors utilization patterns to identify high-risk cases and clarifies benefits for providers, while also making outbound calls to members. This position is fully remote and plays a crucial role in supporting the health plans' mission to provide quality care.

  • Intake information regarding the authorization of services for members.
  • Communicate with case managers, PCPs, and members to promote quality service delivery.
  • Monitor members' utilization patterns to identify high-risk cases and service usage issues.
  • Clarify benefits for providers to ensure proper service delivery.
  • Make outbound (cold) calls to members to gather necessary information.
  • High school diploma or equivalent.
  • Two years' experience in a medical practice office, urgent care, hospital, skilled nursing facility, or other healthcare setting, along with completion of a medical-related training program (e.g., Medical Assistant, EMT, Nursing Assistant).
  • Alternatively, three years' experience in a medical practice office, urgent care, hospital, skilled nursing facility, or other healthcare setting.
  • One year of Managed Care Utilization review experience.
  • Experience and knowledge of the preauthorization process for medical services.
  • Physician office experience.
  • Knowledge of Medicare, HMO, PPO, TPA, PHO, and Managed Care functions.
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service