Clinical Utilization Management Reviewer/Customer Service 

Overview

Looking for full-time work (8 hours/day)

at $8.60/hour ($1,513.60/month)

Bachelors degree

Last Active

April 20th, 2024 (6 days ago)

Member Since

February 19th, 2021

Profile Description

Performs UM reviews (prospective/concurrent/retrospective) for inpatient and outpatient services according to the prescribed standards and client requirements and/or policies.
Performs Utilization Management (UM) reviews in accordance with U.S. State/Federal and other mandated regulations. Maintains compliance with regulatory changes affecting UM. Reviews UM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer or prescribed escalation protocol.
Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results.  

Provide excellent customer service to credit card applicants.
Make sure that all information gathered through phone is accurate and compliant with regulatory standards.
Stay up to date on all changes, developments and enhancements for all systems, products and upgrades.
Advice customers of products that may benefit them .