Utilization Management Representative II

CareBridge-posted 2 months ago
$19 - $31/Yr
Full-time • Entry Level
Rancho Cordova, CA
251-500 employees
Ambulatory Health Care Services
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The Utilization Management Representative II is responsible for conducting service coordination functions for a defined caseload of individuals. This role enables associates to work virtually full-time in CALIFORNIA, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

  • Managing incoming calls
  • Determine contract and benefit eligibility; creates authorizations for LTSS members.
  • Obtains intake (demographic) information from LTSS providers.
  • Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
  • Processes incoming requests, collection of information needed for review from providers.
  • Verifies benefits and/or eligibility information.
  • May act as a liaison between LTSS and internal departments.
  • Responds to telephone and written inquiries from providers and in-house departments.
  • Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long term services and supports.
  • May also serve as to mentor, subject matter expert or preceptor for new staff, assisting the formal training of associates, and may be involved in process improvement initiatives.
  • Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.
  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Previous experience working in a social work setting preferred.
  • BA/BS degree is preferred in the field of health care.
  • Specific education, years and type of experience may be required based upon state law and contract requirements.
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
  • Paid Time Off
  • Medical, dental, vision benefits
  • Short and long term disability benefits
  • Life insurance
  • Wellness programs
  • Financial education resources
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