Utilization Management CNA
About The Position
We are seeking a dedicated Utilization Management Assistant to join our healthcare team. This role involves answering first-level calls in Utilization Review for Health & Wellness participants. The assistant will evaluate certification requests by reviewing group-specific requirements and triage calls to determine if a Utilization Review Nurse is needed. Responsibilities include reviewing medical records, coordinating with healthcare providers, and ensuring patients receive appropriate, cost-effective care in accordance with clinical guidelines and insurance requirements. This position offers daytime office hours with weekends and holidays off.
Requirements
- Experience in a medical setting (e.g., receptionist, scheduler, insurance verification, LPN, CNA, Medical Assistant) or background in customer service.
- 1+ years of experience within patient health support or care.
- 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.
Nice To Haves
- CNA, LPN, or Medical Assistant preferred.
Responsibilities
- Answer first-level calls in Utilization Review for Health & Wellness participants.
- 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.
- Ensure patients receive appropriate, cost-effective care in accordance with clinical guidelines and insurance requirements.
Benefits
- Medical Insurance
- Dental Insurance
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
