This job will have the following responsibilities:
Responsible for providing non-clinical support to the Medical Management and/or Operations areas.
Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Provides information regarding network providers or general program information when requested.
May assist with complex cases. May act as liaison between Medical Management and/or Operations and internal departments.
Maintains and updates tracking databases. Prepares reports and documents all actions.
Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Qualifications & Requirements:
Requires a high school diploma; 1 year of experience with an understanding of managed care or Medicaid/Medicare; or any combination of education and experience, which would provide an equivalent background.
This job and many more are available through The Judge Group. Find us on the web at www.judge.com