Utilization Management Assistant

Cottingham & Butler•Des Moines, IA

9h•Hybrid

About The Position

The Utilization Management Assistant answers first level calls in Utilization Review for our Health & Wellness 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

Experience in a medical setting (e.g., receptionist, scheduler, insurance verification, LPN, CNA, Medical Assistants, or customer service).
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 connect with patients, doctors, internal team members, and providers.
Friendly demeanor and understanding 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 Health & Wellness 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.