Utilization Review Assistant

The Utilization Review Assistant is responsible for the administrative components of Utilization Management that primarily focuses on supporting the medical review process.

Skills and Abilities

Essential Technical/Motor Skills

• Hand/eye coordination: speaks clearly; good hearing, ability to use computers, printers and telephone equipment
• Interpersonal skills
• Ability to work as a member of a team and develop trusting relationships quickly
• Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities.

Interpersonal Skills

Essential Physical Requirements

Essential Mental Abilities

• Implements and provides ongoing support of members care plan, recognizes alternatives, identifying problems.
• Provides patient and family teaching about health related needs, financial needs and other coping issues.
• Concentrates on plans and roles of other team members, understanding all responsibilities and plans.

Essential Sensory Requirements

• Visual and hearing skills to obtain a driver's license are required.
• Ability to communicate with members and families, communicating in person and on phone.

Exposure to Hazards

Other Skills and Abilities

• Must have access to transportation
• Responsible for communication of required healthcare documents to patients and/or representatives.
• Adhere to regulatory and compliance standards
• Understanding benefits including Medicaid and Medicare
• Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs.
• Documentation entry
• Phone and Voicemail retrieval
• Mail distribution within the department
• Worklist management
• Other duties assigned

Education

• H.S. Diploma - or GED - Required

Work Experience

• Experience in healthcare, managed care, hospital, or clinical setting, or other comparable work experience. - Preferred

Licenses and Certifications

• Upon Hire

Travel Requirements

• Travel to off-site locations may be required. - Required
• Responsible for communication of required healthcare documents to patients and/or representatives.
• Adhere to regulatory and compliance standards
• Understanding benefits including Medicaid and Medicare
• Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs.
• Documentation entry
• Phone and Voicemail retrieval
• Mail distribution within the department
• Worklist management
• Other duties assigned

Education

• H.S. Diploma - or GED - Required

Work Experience

• Experience in healthcare, managed care, hospital, or clinical setting, or other comparable work experience. - Preferred

Licenses and Certifications

• Upon Hire

Travel Requirements

• Travel to off-site locations may be required. - Required