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Job Title: Utilization Management Rep I
Duration: 6 Months
Location: Indianapolis, Indiana 46204

Shift Timings: Mon-Fri in-between 8Am to 8Pm.

Description:
1. Do candidates need to have call center experience or will you consider candidates from other backgrounds as well Candidates need to have call center experience.
2. Will these candidates be taking inbound phone calls and if so what is the volume expected Yes, inbound calls only. Expected volume is approx.. 60-80 per day. It varies depending on the day and time of year.
3. Will you consider candidates without healthcare experience Healthcare experience is preferred, but not a deal breaker.
4. What type of metrics will the candidates be measured on Production/Quality/Behavioral (which includes attendance, overall attitude, and adhering to policies and procedures)
5. How are the shifts determined Since we are opened from 8am-8pm, our newer staff usually has the 11am-8pm shift and we adjust those already on that shift to an earlier. We meet with our WFM Team to determine how many people are needed on what schedule.
6. What does the training process look like Approx. 5-6 weeks in a training class (virtual) and 2 weeks with a preceptor.
7. What does your interview timeline and process look like (i.e. phone or in person) In person interviews and we like to do group interviews.

Responsibilities:
• Responsible for coordinating cases for precertification and prior authorization review.
• Primary duties may include, but are not limited: Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refers cases requiring clinical review to a Nurse reviewer. Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process.
• Authorizes initial set of sessions to provider. Checks benefits for facility based treatment. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Requires High school diploma/GED; 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background. Medical terminology training and experience in medical or insurance field preferred.