Utilization Review Assistant

About the role

The Utilization Review Assistant is responsible for the administrative components of Utilization Management that primarily focuses on supporting the medical review process.

Responsibilities

• Communication of required healthcare documents to patients and/or representatives.
• Adhere to regulatory and compliance standards.
• Understand benefits including Medicaid and Medicare.
• Work closely with utilization review staff, care managers, and social workers to assist with any administrative responsibilities or needs.
• Documentation entry.
• Phone and voicemail retrieval.
• Mail distribution within the department.
• Worklist management.
• Other duties as assigned.

Requirements

• High School Diploma or GED (Required).
• Experience in healthcare, managed care, hospital, or clinical setting, or other comparable work experience (Preferred).
• Travel to off-site locations may be required.
• Must have access to transportation.

Skills and Abilities

Essential Technical/Motor Skills

• Hand/eye coordination: speaks clearly; good hearing, ability to use computers, printers, and telephone equipment.

Interpersonal Skills

• Ability to work as a member of a team and develop trusting relationships quickly.
• Excellent verbal and written communication skills, including sensitivity to other cultures and ethnicities.

Essential Physical Requirements

• Visual and hearing skills to obtain a driver’s license are required.
• Ability to communicate with members and families, both in person and on the phone.

Essential Mental Abilities

• Implements and provides ongoing support of members' care plans, recognizes alternatives, and identifies problems.
• Provides patient and family teaching about health-related needs, financial needs, and other coping issues.
• Concentrates on plans and roles of other team members, understanding all responsibilities and plans.