The Utilization Management Technician functions under the direction of the Supervisor, Utilization Management and/or designee to coordinate, generate and track both incoming and outgoing correspondence, related to the member for services or prospective services. Interacts with members, providers, facilities and other AmeriHealth staff to implement the program interventions, facilitate receipt of information and records for prompt review and response by the clinical staff.
* Supports the daily operations of Utilization Management team through interaction with staff, facilities, vendors and providers.
* Maintains a current knowledge base of Utilization Management processes and timelines.
* Uses good listening skills, conducts outreach calls, collecting data according to script, tools, and protocols meeting both productivity and performance expectations as identified by unit supervisor/or designee. Conducts all calls in a courteous and customer service friendly manner. Refers as appropriate when indicated by workflow.
* Creates, updates maintains and/or closes authorizations or tasks for services as assigned within process guidelines. Routes case to appropriate AmeriHealth associates based on established guidelines.
* Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow.
* Performs in a call center environment appropriately processing or triaging calls from members and providers.
* Clerical responsibilities such as processing urgent scanning, mailing requests, document retrieval, and projects as assigned.
* Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution.
* Adhere to AmeriHealth Policies and Procedures, process standards, and Standard Operating Procedures
* Performs other related duties and projects as assigned within the assigned timeframes.
* Adheres to AmeriHealth policies and procedures.
* Complies with AmeriHealth and HIPAA confidentiality standards to protect the confidentiality of member information
* High School Diploma Required.
* Medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification.
* Medical Terminology highly recommended.
* Prior member service or customer service telephone experience desired.
* Preferred but not required, certification as a para-professional, medical assistant, home health aide, or nursing assistant a plus.