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Utilization Review Specialist

at logisticare

Posted: 10/24/2017
Job Reference #: 5000269687706
Keywords: office

Job Description

Job Title

Utilization Review Specialist

Requisition Number

17-5502

Job Description

POSITION SUMMARY

The Utilization Review Specialist is responsible for managing member utilization.

ESSENTIAL FUNCTIONS

Determines member eligibility

Verifies the appropriateness of service levels

Manages the denial and appeal process

Monitors exceptional distance report

Confirms utilization of the closest medical provider of services

Assists with standing order recertification

Audits whether provider billed for previously cancelled trips and/or was paid for trips that did not occur

Performs other duties as assigned

POSITION QUALIFICATIONS

Competency Statement(s)

Communication, Oral - Ability to communicate effectively with others using the spoken word

Communication, Written - Ability to communicate in writing clearly and concisely

Decision Making - Ability to make critical decisions while following company procedures

Interpersonal - Ability to get along well with a variety of personalities and individuals

Problem Solving -- Ability to find a solution for or to deal proactively with work-related problems

RelationshipBuilding -- Ability to find a solution for or to deal with customers and co-workers

Education

High School Graduate or General Education Degree (GED) required

Experience

Prior experience in a medical office preferred; social services or case management experience is a plus

SKILLS & ABILITIES

Superior customer service and phone skills

Strong verbal communication, writing, problem solving, time management, and organizational skills

Must possess professional writing skills and ability to correspond with professionals both verbally and in writing

Ability to type 35 corrected words per minute

Must have strong spreadsheet and database skills to include intermediate proficiency with Microsoft Excel, Word and Outlook)

SUPERVISORY RESPONSIBILITIES

None

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

While performing the duties of this Job, the employee is regularly required to talk or hear. The employee is frequently required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, reach with hands and arms and lift. Specific vision abilities required by this job include close vision.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Entire work time is conducted in an office environment in a controlled atmosphere building.

 

The noise level in the work environment is usually moderate.

Work Location(s)

5875 NW 163rd Street, Ste 203, Miami, Florida 33156

Full-Time/Part Time

Full-time

Requirements