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Utilization Mgmt Tech

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POST DATE 9/17/2016
END DATE 12/21/2016

Superior Group North Charleston, SC

Location
North Charleston, SC
AJE Ref #
576204171
Job Classification
Full Time
Job Type
Regular
Company Ref #
378774
Education
High School Diploma or GED

JOB DESCRIPTION

Superior Group is looking for a Utilization Mgmt Tech for our client located in North Charleston, SC

Screens information received and refers members to the appropriate provider and 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.
Supports Utilization Management nurses with data entry.
Performs other duties as assigned.
Adheres to Select Health and KMHP policies and procedures.
Supports and carries out the Select Health and Mercy Mission & Values.
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.

Required Skills / Qualifications:

Minimum of 4 years’ experience as Utilization Mgmt Tech


Go Beyond. www.superiorjobs.com.
EEO Employer - Minorities / Females / Disabled / Veterans / Sexual Orientation / Gender Identity.

Overview

Superior Technical Resources, Inc. provides staff augmentation, direct placement, and outsourced human resource solutions. It offers a range of staffing services, including contract staffing, direct hire, pay rolling services, onsite staffing, and Web-based vendor management programs, as well as Web-enabled automated managed service programs in engineering, design, drafting, finance, human resources, management, information technology, and other professional/technical disciplines.

The company serves aircraft/aerospace, computer, electronics, manufacturing, semiconductor, software, telecommunications, and utilities sectors.