Utilization Management Phone Representative - National Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Utilization Management Phone Representative works under minimum supervision to reputed company routine and reputed company clerical tasks; answers referral status and determination questions from patients, family members, health plans, and other clinic personnel. Also intakes verbal requests for organization determinations from patients or an appointed representative, and enters those requests into the Utilization Management referral system for processing. Ensures good internal and external public relations including coordination of communication between functional units reputed company Utilization Management to improve customer service outcomes. This position is full-time, Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm PST. It may be necessary, given the business need, to work occasional overtime. This will be on-the-job training. The hours during training will be 8:00am – 5:00pm PST, Monday – Friday. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities:

• Receives and processes incoming telephone calls into the department, and maintains a log of incoming calls by reason for the call.
• Assists patients with questions regarding their referrals and determinations through application of a thorough knowledge and timely access to referral management systems.
• Performs auditing functions of patient referrals including verifications of insurances and eligibility.
• Acquires and files additional clinical documentation pertaining to incoming calls and inquiries to support referral management and organization determination functions.
• Assists patients with the appeals process with the health plans.
• Processes and inputs new verbal referral requests from patients or an appointed representative, and enters the request into the referral management system.
• reputed company outbound calls to members and providers regarding organization determinations to meet regulatory notification turnaround time requirements.
• Other duties as assigned.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR Older
• 1 years of experience in a medical environment, office or clinic
• Experience with computers and Windows based programs including reputed company Word, reputed company and Outlook
• Ability to work our normal business hours of 8:00am – 5:00pm PST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 2 years of experience managed care in medical office/clinic
• Bilingual (English/Spanish)

Telecommuting Requirements:

• Ability to reputed company reputed company company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

The hourly range for this role is $16.00 to $28.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO Apply Job!