Utilization Management CNA

Responsibilities

• Answer first level calls in Utilization Review for HealthCheck360 participants.
• Evaluate certification requests by reviewing the group specific requirements.
• Triage calls to determine if a Utilization Review Nurse is needed to complete the call.
• Review medical records.
• Congnorate with healthcare providers.
• Ensure that patients receive appropriate, cost-effective care in accordance with clinical guidelines and insurance requirements.

Requirements

• CNA, LPN, or Medical Assistant preferred.
• Background in patient health support or care.
• 1+ years of experience within this field.

Qualifications

• Communication - Strong interpersonal skills to be able to connect with patients, doctors, internal team members, and providers.
• Customer Service - Friendly demeanor and understanding to be able to relay sensitive information to members.
• Detail Oriented - Accuracy and attention to detail when reviewing pre-certifications and plans.

Benefits

• Full-Time Benefits - Most benefits start day 1.
• Medical, Dental, Vision Insurance.
• Flex Spending or HSA.
• 401(k) with company match.
• Profit-Sharing/Defined Contribution (1-year waiting period).
• PTO/Paid Holidays.
• Company-paid ST and LT Disability.
• Maternity Leave/Parental Leave.
• Subsidized Parking.
• Company-paid Term Life/Accidental Death Insurance.

About HealthCheck360

HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs.