Utilization Management Rep I
Our client, located in Tampa, FL currrently has an opening for a Utilization Management Rep!
Responsible for coordinating cases for precertification and prior authorization review.
Primary duties may includes, but are not limited: Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Working hours: 8:00 AM - 5:00 PM
Medcical background a plus
Proficient in MS Excel
Ability to manage multiple projects
Excellent written communication skills
Please apply at www.randstadusa.com for consideration!
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