Utilization Management Assistant

 
Position: Utilization Management Assistant

Job ID: 153441

Location: US-TX-Bellaire

Department: UM ASSISTANTS

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at 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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