Utilization Management CNA

HealthCheck360 • Dubuque, IA

15h • Hybrid

About The Position

The Utilization Management Assistant answers first level calls in Utilization Review for HealthCheck360 participants. They will evaluate certification requests by reviewing the group specific requirements and will also triage the call to determine if a Utilization Review Nurse is needed to complete the call. You will be responsible for reviewing medical records, coordinating with healthcare providers, and ensuring that patients receive appropriate, cost-effective care in accordance with clinical guidelines and insurance requirements.

Requirements

• Background in patient health support or care
• 1+ years of experience within this field

Nice To Haves

• CNA, LPN, or Medical Assistant preferred
• Strong interpersonal skills to be able to connect with patients, doctors, internal team members, and providers
• Friendly demeanor and understanding to be able to relay sensitive information to members
• Accuracy and attention to detail when reviewing pre-certifications and plans

Responsibilities

• Answers first level calls in Utilization Review for HealthCheck360 participants.
• Evaluates certification requests by reviewing group specific requirements.
• Triage calls to determine if a Utilization Review Nurse is needed.
• Reviews medical records.
• Coordinates with healthcare providers.
• Ensures patients receive appropriate, cost-effective care in accordance with clinical guidelines and insurance requirements.

Benefits

• Medical, Dental, Vision Insurance
• Flex Spending or HSA
• 401(k) with company match
• Profit-Sharing/Defined Contribution (1-year waiting period)
• PTO/Paid Holidays
• Company-paid ST and LT Disability
• Maternity Leave/Parental Leave
• Subsidized Parking
• Company-paid Term Life/Accidental Death Insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed