Utilization Management Rep

Direct Staffing Inc; Thousand Oaks (CA); On-site; Full time

Job summary

A staffing agency is looking to hire several Site Logistics Operators in Knoxville, TN for a leading chemical company. The role requires coordinating cases for precertification, managing claims, and requires a high school diploma/GED. Ideal candidates should have medical terminology knowledge and at least one year of call-center experience. Strong communication and organizational skills are essential for success. This is a long-term, indefinite assignment in a dynamic environment.

Qualifications

• Medical terminology training and experience in the medical or insurance field.
• A minimum of 1 year of call-center experience.
• Strong organizational skills and ability to multi-task.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and claims work.
• Check benefits for facility-based treatment.

Skills

Analytical skills

Written communication

Oral communication

Computer navigation

Time management

Education

High school diploma/GED

Job description

Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical Finished Product Operator or a Polymers Packaging/Warehousing/Shipping Operator on a long-term, indefinite assignment. You will be working with chemicals and should be comfortable doing such - either with previous experience or the willingness to learn.

Job Description

Responsibilities include:

• Responsible for coordinating cases for precertification and prior authorization review.
• 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.
• Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks benefits for facility based treatment.

Qualifications

Job Requirements:

• Requires High school diploma/GED.
• Medical terminology training and experience in medical or insurance field.
• A minimum of 1 year of call-center experience; proficient analytical.
• Strong written and oral communication skills.
• Good computer navigation/keyboarding skills.
• Ability to multi-task, well organized, and good time management skills.

Additional Information

All your information will be kept confidential according to EEO guidelines.