Utilization Review Specialist

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POST DATE 8/12/2016
END DATE 12/23/2016

Logisticare Long Island City, NY

Long Island City, NY
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
High School Diploma or GED


- High school graduate or equivalent

- Prior experience in medical office, social service or case management
experience a plus.

- Superior customer service and phone skills; strong verbal communication, writing, problem solving, time management, and organizational skills

- Must possess professional writing skills and ability to correspond with professionals both verbally and in writing

- Ability to accurately type 35 words per minute

- Must have strong spreadsheet and database skills to include intermediate proficiency with Microsoft Excel, Word and Outlook)

Environmental and Working Conditions:
- Entire work time is conducted in an office setting

Physical and Mental Requirements:
- Must be able to understand and follow complex instructions

Job Description:
LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare s client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.

We seek a Utilization Review Specialist to join our growing company.

Essential Duties and Responsibilities:

- Determines member eligibility

- Verifies the appropriateness of service levels

- Manages the denial and appeal process

- Monitors exceptional distance report

- Confirms utilization of the closest medical provider of services

- Assists with standing order recertification

- Audits whether provider billed for previously cancelled trips and/or was paid for trips that did not occur

- Performs other duties as assigned

Note: This description is not intended to be all-inclusive. Employee may be requested to perform other duties from time to time.

LogistiCare is an Equal Opportunity Employer.