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Utilization Review Specialist at LogistiCare

Posted in Other 10 days ago.

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Type: Full Time
Location: Charleston, West Virginia

Job Description:

The Utilization Review Specialist is responsible for managing member utilization.

Essential Duties and Responsibilities:
- 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

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

LogistiCare is an Equal Opportunity Employer.

-High School Graduate or General Education Degree (GED) required

- Prior experience in medical office, social service or case management
experience a plus.

- 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 accurately type 35 words per minute
- Must have strong spreadsheet and database skills to include intermediate proficiency with Microsoft Excel, Word and Outlook)

Environmental and Working Conditions:
- Entire work time is conducted in an office setting

Physical and Mental Requirements:
- Must be able to understand and follow complex instructions

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled