Utilization Management Assistant

 
Position: Utilization Management Assistant

Job ID: 158148

Location: US-TX-Bellaire

Department: UM ASSISTANTS

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 9a-6p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   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.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Utilization Management Assistant -- 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. This role also assists and collaborates with all medical management staff, as well as provides customer service and education for all incoming calls regarding provider and/or product information.

 

Think you’ve got what it takes?



Responsibilities :

  • Serves as support to Medical Management Intake Department
  • Performs data entry of authorization information into systems, and or fax information to, originating physician and or facility or specialist
  • Primarily responsible for processing initial incoming faxes or phone requests into the intake department, gathering demographic and benefit data and documenting in appropriate system
  • Confirms eligibility for requested authorizations and for requesting membership identification numbers for newborns
  • Assists Member Services and Network Development departments by providing communication and education regarding authorization status and processes and changes
  • Discusses with providers the availability and accessibility of specialists, and assists as necessary, and refers issues to appropriate parties
  • Assists and educates providers in questions relating submission of detail for SSI authorizations, content and timeframes necessary for continued stay authorizations
  • Receives transfer calls from member services relating to authorization issues, questions or capabilities of service providers


Qualifications:

  • High school diploma or GED required
  • Some college work preferred
  • 2 years managed care experience in a medical management or claims and member service department preferred
  • Experience in healthcare or insurance environment preferred


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