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Utilization Management Technician

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POST DATE 8/13/2016
END DATE 12/21/2016

Superior Group North Charleston, SC

North Charleston, SC
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
High School Diploma or GED


Superior Group is seeking a Utilization Management Technician to work with our client in N. Charleston! This is a contract opportunity expected to last for about 3 months.

Principal Accountabilities:

Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.
Facilitates the authorization process for requests that do not require clinical criteria application or judgment.
Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available.
Acts as a resource to staff for questions related to the prior authorization process.
Refers unresolved prior authorization process questions to the Lead Intake Specialist.
Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.
Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.
Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.
Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.

Required Skills / Qualifications:

High School Diploma or equivalent
Minimum 1 year of experience working with medical terminology
Minimum 1 year of experience working in a call center setting

Key Competencies/Success Factors:

Excellent interpersonal and verbal communication skills.
Attention to detail and confidentiality.
Patience and a balanced demeanor.
Professional image.
Ability to write clear and concise reports.
Willingness to work any shift.
Availability for in-service training.

Go Beyond.
EEO Employer – Minorities / Females / Disabled / Veterans / Sexual Orientation / Gender Identity.