Utilization Management Services Rep I

Utilization Management Workflow Support

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment.

Essential Accountabilities:

• Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment.
• Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies.
• Perform triage for UM Services.
• Serves as the primary contact for providers regarding authorization requests.
• Contacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for Quality Assurance (NCQA) guidelines.
• Provides timely response to all research inquiries from other departments and assures the response is thorough, accurate, and within regulatory timeframes.
• Processes fax requests from the designated fax and system queues.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• High School Diploma or GED.
• Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.
• Call center experience preferred, not required.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work within a team.
• Demonstrated organizational skills to manage multiple projects and priorities.
• Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.

Physical Requirements:

• Ability to work prolonged periods sitting at a workstation and working on a computer.
• Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Manual dexterity including fine finger motion required.
• Repetitive motion required.
• The ability to hear, understand and speak clearly while using a phone, with or without a headset.

Equal Opportunity Employer

Compensation Range(s): N3 - Min $20.00 Max $26.90