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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!
Job Responsibility:
Answers first level calls in Utilization Review for HealthCheck360 participants
Evaluate certification requests by reviewing the group specific requirements
Triage the call 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
Requirements:
CNA, LPN, or Medical Assistant preferred
Background in patient health support or care
1+ years of experience within this field
Strong interpersonal skills
Friendly demeanor and understanding
Accuracy and attention to detail when reviewing pre-certifications and plans