Remote Clinical Review Assistant: Utilization Management

bcbst; Chattanooga (TN); On-site; USD 34,000 - 42,000; Full time

Job summary

BCBST is seeking a Clinical Assistant to support BlueCare Plus Clinical Review Managers by serving as a primary contact for providers and healthcare partners. You will assist with inquiries, load authorizations, enter requests received by phone, and guide providers through the peer-to-peer review process to ensure timely, accurate support.

The ideal candidate has medical office or senior care experience, strong communication, patience, attention to detail, and the ability to work independently.

Qualifications

• High School Diploma or equivalent is required.
• 1 year of customer service experience is required.
• Completes digital literacy assessments and participates in ongoing training.
• Proficient in Microsoft Office and strong verbal/written communication.
• Knowledge of Utilization Management, Care Management and Behavioral Health preferred.

Responsibilities

• Screen incoming calls/faxes and direct to UM/CM; refer cases appropriately.
• Investigate and resolve inquiries and claims; maintain department goals.
• Load organization determinations per internal policy; document data in systems.
• Interact with members, hospital and provider staff to advise UM decisions and status.
• Search for and enter diagnosis/procedure codes as part of notification/pre-authorization.

Skills

Microsoft Office

Communication skills

Interpersonal skills

Time management

Decision making

Medical terminology

Utilization Management

Medical coding knowledge

Typing while talking

Education

High School Diploma

Job description

BCBST is seeking a Clinical Assistant to support BlueCare Plus Clinical Review Managers by serving as a primary contact for providers and healthcare partners. You will assist with inquiries, load authorizations, enter requests received by phone, and guide providers through the peer-to-peer review process to ensure timely, accurate support.

The ideal candidate has medical office or senior care experience, strong communication, patience, attention to detail, and the ability to work independently.