Utilization Management Assistant - The Health Plan

 
Position: Utilization Management Assistant - The Health Plan

Job ID: 154741

Location: US-TX-Bellaire

Department: UM ASSISTANTS

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

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 an Utilization Management Assistant with The Health Plan ­– someone who works well in a fast-paced setting. In this position, you will receive, process and complete data entry of demographic information on all referral/authorization requests from participating providers via fax or phone. You will also assist and collaborate with all medical management staff, as well as other health plan staff.

 

Think you’ve got what it takes?



Responsibilities :

  • Serves as support to Medical Management Intake Department
  • Primarily responsible for processing initial incoming faxes or phone requests into the intake department Gathering demographic and benefit data and documenting in appropriate system. This is determined through documented policy and procedures.
  • Performs data entry of authorization information into systems, and or fax information to, originating physician and or facility or specialist.
  • Assists Member Services and Network Development departments by providing communication and education regarding authorization status and processes and changes.
  • Collaborates 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 required
  • Some college coursework preferred
  • 2 years’ experience in managed care, preferably in medical management department, claims and member service preferred
  • Experience in Healthcare or Insurance environment preferred

 



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