Utilization Review & Case Management Specialist

NOR Healthcare Systems Corp.; Bellflower (CA); Presencial; USD 32.000 - 41.000; Jornada completa

Descripción de la vacante

NOR Healthcare Systems Corp. is seeking an Utilization Review Specialist to support the Case Management Department under the Director/Manager.

This role interfaces with payors and providers to obtain authorizations, medical records, and necessary information, ensures timely submissions, and aids in coordinating daily operations. Responsibilities include conducting reviews, reducing denials with centralized processes, assisting with schedule coordination, and performing clerical tasks to keep the

Formación

• 2 years works experience
• Must demonstrate customer service skills
• Excellent written and verbal communication skills
• Ability to multitask and maintain a workload pace

Responsabilidades

• Interfaces with payors and providers requesting authorizations, medical records, and other information.
• Completes payor and provider request for missing or additional documentation.
• Logs all authorization requests to ensure same-day submission.
• Forwards questions and authorizations to Director/Manager of Case Management.
• Performs basic reception functions to ensure smooth office operations.
• Types memos and documents, uses computer programs, and collects data into systems.
• Clears providers prior to patient access and ensures privacy guidelines are followed.
• Maintains audits for timely completion of Utilization Reviews and retroactive reviews.
• Cross references data for PI/Quality indicators and prepares presentations.

Descripción del empleo

NOR Healthcare Systems Corp. is seeking an Utilization Review Specialist to support the Case Management Department under the Director/Manager.

This role interfaces with payors and providers to obtain authorizations, medical records, and necessary information, ensures timely submissions, and aids in coordinating daily operations. Responsibilities include conducting reviews, reducing denials with centralized processes, assisting with schedule coordination, and performing clerical tasks to keep the