Utilization Management Coordinator

Decton Staffing Services

Decton is recruiting for Utilization Management Customer Service Representatives for a Health Plan company in Aliso Viejo paying $22 an hour. If you are interested please submit your resume and call/text Yesenia Montano 949-207-1005.

JOB SUMMARY

The UM Customer Service Representative is responsible for successfully managing a high volume of inbound and outbound calls while providing exemplary customer service. Performing this activity will include following communication scripts, addressing many different situations, and acting as a liaison between its Health Plan partners, patients, providers, and vendors. In addition, the UM Customer Service Representative is responsible for evaluating incoming documents to determine if required information is complete or if outreach is needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Manages incoming calls from physicians, ancillary providers, patients, and plan representatives regarding referral authorization requests and requirements.
  • Accurately tracks and enters calls in computer system using appropriate documentation, reporting, and database applications.
  • Reviews incoming phone referral requests for completeness of information provided.
  • Functions as a liaison between members as well as providers regarding authorization requests, physician/vendor information, and complaint resolution. Aware when to escalate issues to a higher level.
  • Interacts with plan partners and multiple departments, e.g., Utilization Management, Claims, and Eligibility to provide resolution to provider, member, and health plan/vendor inquiries. Supports positive internal relations and communication across all areas.
  • Understands and uses proper procedures to resolve problems, escalate issues, and achieve objectives in a productive and cooperative manner. Provides timely feedback about processes to improve caller experiences and satisfaction.
  • Notifies members of urgent approvals and denials within appropriate time frames, using appropriate guidelines.
  • Supports overall department operations through cooperation and teamwork.

QUALIFICATIONS

  • High School Diploma.
  • Knowledge of Medical Terminology.
  • Ability to navigate multiple PC applications simultaneously. Knowledge and experience using Microsoft ® Office required.
  • Minimum of two (2) years of outbound/inbound calling experience in a call center, medical office/clinic or institutional setting.
  • Ability to convey a positive and professional image to customers and employees.
  • Display patience and demonstrates respect for callers and staff. Maintains composure in high pressure situations.
  • Willing and able to follow an issue through to its conclusion.
  • Excellent written/verbal communication skills.
  • Ability to work in a fast-paced environment and maintain a high level of productivity.
  • Ability to prioritize and handle multiple tasks effectively and efficiently, remain flexible, and adapt to shifting work demands.
  • Strong organizational and time management skills. Able to work independently, but also as a team player.
  • Customer service experience in a managed care environment highly desirable.