Utilization Management Rep

Partnered Staffing - Kelly Services
 Thousand Oaks, CA

Company Description

Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical Finished Product Operator or a Polymers Packaging/Warehousing/Shipping Operator on a long-term, indefinite assignment. You will be working with chemicals and should be comfortable doing such - either with previous experience or the willingness to learn.

Job Description

Responsibilities include:

Responsible for coordinating cases for precertification and prior authorization review.

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.

Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks benefits for facility based treatment.


Job Requirements:

Requires High school diploma/GED.

Medical terminology training and experience in medical or insurance field

A minimum of 1 year of call-center experience; proficient analytical.

Strong written and oral communication skills

Good computer navigation/keyboarding skills.

Ability to multi-task, well organized, and good time management skills.

Additional Information

All your information will be kept confidential according to EEO guidelines.