Utilization Management CNA

HealthCheck360; United States; Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Flex Spending/HSA

401(k) with company match

PTO/Paid Holidays

Company-paid Disability

Maternity Leave/Parental Leave

Subsidized Parking

Term Life/AD&D Insurance

Job summary

HealthCheck360 is seeking a dedicated Utilization Management Assistant to join our clinical operations team in Dubuque, IA, with options for remote applicants. The role handles first-level Utilization Review calls, reviews certifications, triages to a nurse when needed, and supports coordinating with providers to ensure appropriate, cost-effective care.

The ideal candidate has CNA/LPN/Medical Assistant experience, 1+ year in health support, and strong communication with patients and staff;

Qualifications

• 1+ years of experience in health support or care.
• CNA, LPN, or Medical Assistant preferred.
• Background in patient health support or care.

Responsibilities

• Answer first level calls in Utilization Review for HealthCheck360 participants.
• Evaluate certification requests by reviewing group-specific requirements.
• Triage to determine if a Utilization Review Nurse is needed.
• Review medical records and coordinate with healthcare providers.
• Ensure patients receive appropriate, cost-effective care per clinical guidelines and insurance requirements.

Skills

Communication

Customer Service

Detail Oriented

Education

CNA/LPN/Medical Assistant preferred

Background in patient health support or care

Job description

Utilization Management Assistant

Location

Onsite in Dubuque, IA. Also accepting remote applicants.

Are you passionate about patient care and thrive in a fast-paced, professional environment? We are seeking a dedicated Utilization Management Assistant to join our healthcare team. We are looking for individuals with experience in a medical setting, including but not limited to a receptionist, scheduler, insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer service who are looking to make a meaningful impact behind the scenes. If you are looking to get into a professional office setting with daytime office hours and weekends/holidays off, this is the role for you!

The Utilization Management Assistant answers first level calls in Utilization Review for HealthCheck360 participants. They will evaluate certification requests by reviewing the group specific requirements and will also triage the call to determine if a Utilization Review Nurse is needed to complete the call. You will be responsible for reviewing medical records, coordinating with healthcare providers, and ensuring that patients receive appropriate, cost-effective care in accordance with clinical guidelines and insurance requirements.

Preferred Skills

• Communication - Strong interpersonal skills to be able to connect with patients, doctors, internal team members, and providers
• Customer Service - Friendly demeanor and understanding to be able to relay sensitive information to members
• Detail Oriented - Accuracy and attention to detail when reviewing pre-certifications and plans

Qualifications

• CNA, LPN, or Medical Assistant preferred
• Background in patient health support or care
• 1+ years of experience within this field

Full-Time Benefits

Most benefits start day 1

• Medical, Dental, Vision Insurance
• Flex Spending or HSA
• 401(k) with company match
• Profit-Sharing/Defined Contribution (1-year waiting period)
• PTO/Paid Holidays
• Company-paid ST and LT Disability
• Maternity Leave/Parental Leave
• Subsidized Parking
• Company-paid Term Life/Accidental Death Insurance

About HealthCheck360

HealthCheck 360 was created with the employer’s needs and the participant’s experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs.