Utilization Management CNA
About The Position
Are you passionate about patient care and thrive in a fast-paced, professional environment? We are seeking a dedicated Utilization Management Assistant to join our healthcare team. This role is ideal for CNAs, Medical Assistants, LPNs, or individuals with a background in patient health support who are looking to make a meaningful impact behind the scenes. If you are looking to get into a professional office setting with daytime office hours and weekends/holidays off, this is the role for you! 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
- CNA, LPN, or Medical Assistant preferred
- Background in patient health support or care
- 1+ years of experience within this field
Nice To Haves
- Communication - Strong interpersonal skills to be able to connect with patients, doctors, internal team members, and providers
- Customer Service - Friendly demeanor and understanding to be able to relay sensitive information to members
- Detail Oriented - Accuracy and attention to detail when reviewing pre-certifications and plans
Responsibilities
- Answering first level calls in Utilization Review for HealthCheck360 participants.
- Evaluating certification requests by reviewing the group specific requirements
- Triaging the call to determine if a Utilization Review Nurse is needed to complete the call.
- Reviewing medical records
- Coordinating with healthcare providers
- Ensuring that 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
