Utilization Review Case Management Office Specialist

POSITION SUMMARY:

The Utilization Management Office Specialist provides clerical support to clinicians performing utilization review and case management for members hospitalized or receiving other levels of care. The UM office specialist will perform a variety of activities towards quality customer service being consistently delivered to members, families, providers, and facilities. The office specialist will assist in ensuring appropriate care delivery by timely processing of requests for services, notifying providers, obtaining clinical information, assisting clinicians and accurate documentation in the authorization systems. This role must demonstrate proficiency in organizing clinical information, communicating electronically and telephonically, interpreting data, and time management to meet department timeframes. Individuals must have strong computer skills to navigate numerous electronic platforms such as electronic medical records, Microsoft Office, authorization systems, and electronic communication. This position must exercise discretion and independent judgment in performing responsibilities while complying with any and all regulatory requirements including Florida Health Care Plans Policies and procedures.

QUALIFICATIONS:

Education, skills and experience:

• High School Graduate or equivalent.
• Knowledge of general medical and psychiatric terminology preferred.
• Knowledge of ICD-10, CPT coding, preferred.
• General office procedures and equipment (pc, multi-line phone, fax, and copier) required.
• Typing skills of 30wpm, ability to work accurately with firms required.
• Knowledge of Microsoft office suite (experience with MS Word and Excel required).
• Must be able to work rotating weekends.