Utilization Management Assistant

 
Position: Utilization Management Assistant

Location: US-TX-Bellaire

Talent Area: Professional - Clinical

Shift: 10a - 7p

About Texas Children's Hospital

Texas Children’s Health Plan (TCHP) is the largest Texas Medicaid managed care organization, and is part of the Texas Children’s healthcare system. Founded in 1996, TCHP is the nation's first health maintenance organization (HMO) created just for children and pregnant women. Our plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently the Health Plan serves more than 450,000 members across three service areas (Harris, Jefferson, North East). Members of the plan receive care from our network of more than 4,000 primary care physicians, 8,000 specialists, and 110 hospitals. They can also receive care at The Center for Children and Women, a patient and family-centered medical home with two convenient locations for TCHP members who can have all their medical needs met in one place, receiving multiple services the same day. TCHP is a recognized leader at encouraging holistic care that empowers families to live healthier lives.   To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities.   You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Utilization Management Assistant — someone who works well in a fast-paced setting. In this position, you'll receive, process, and complete data entry of demographic information on all referral and authorization requests from participating providers via fax or phone. You will assist and collaborate with all medical management staff, and health plan staff.

 

Think you’ve got what it takes?



Responsibilities :

  • Provide customer service and education for all incoming calls regarding provider and product information
  • Responsible for processing initial incoming faxes or phone requests into the intake department
  • Gather demographic and benefit data and documenting in the appropriate system
  • Confirm eligibility for requested authorizations and membership identification numbers request for newborns
  • Assist member services and network development departments by providing communication and education regarding authorization status and processes and changes
  • Receive transfer calls from member services relating to authorization issues, questions, or capabilities of service providers
  • Collaborate with provider relations in identifying providers in need of education or contracting and trends in authorization requests of out of network utilization


Qualifications:

  • High school diploma or GED
  • Some college course work preferred
  • 2 years of experience in managed care, preferably in medical management department, claims and member services preferred
  • Experience in health care or insurance environment

 



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