Top 6 Utilization management reviewer Jobs in San Antonio, Tx

Intake Representative - CFHP
University Health —San Antonio, TX
- $18.45 - $22.25 an hour
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
3d
Chiropractor
Dane Street, LLC —San Antonio, TX
- Contract
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
Board-Certified Psychiatrist
Dane Street, LLC —San Antonio, TX
- Contract
- Psychiatry
- Analysis skills
- Senior level
Quick Apply

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Chiropractor
Dane Street, LLC —San Antonio, TX
Respond to clinical queries to support claims management. Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review services,…
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Chiropractor
Gonzaba Medical Group —San Antonio, TX
CPR certification with AED is required and must be kept current. Must always adhere to customer service expectations including in-person and virtual (via…
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Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
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Board Certified-(M.D, D.O) Ohio Orthopedic Advisor-Certified for IME
Dane Street, LLC —Delaware, OH
Makes telephone calls as mandated by the state and/or client specifics. Identifies, critiques, and utilizes current criteria and resources such as national,…
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utilization management reviewer jobs near san antonio, tx

Intake Representative - CFHP

University Health -
San Antonio, TX

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Job Details

Full-time
$18.45 - $22.25 an hour
3 days ago

Qualifications

Customer communication
High school diploma or GED

Full Job Description

POSITION SUMMARY RESPONSIBILITIES

Serves as the primary point of contact for utilization management authorization requests received by telephone, fax, electronic submission, provider portal, or other designated intake channels. Performs intake, screening, documentation, tracking, routing, and status communication activities related to utilization management requests. Verifies member eligibility and benefit information, enters authorization requests into designated systems, and ensures requests are routed timely to appropriate clinical reviewers. Provides administrative support to utilization management, care management, and other Population Health functions while maintaining compliance with NCQA, URAC, CMS, Texas Medicaid, HIPAA, and organizational requirements. Does not perform medical necessity reviews or make utilization management determinations. Ensures utilization management requests are processed timely and accurately in accordance with regulatory, contractual, accreditation, and organizational turnaround time requirements

EDUCATION/EXPERIENCE

A high school diploma or equivalent is required. Associate degree, business coursework, healthcare administration coursework, or equivalent experience is preferred. Minimum three (3) years of customer service, healthcare operations, health plan operations, call center, utilization management, prior authorization, claims, or care management support experience preferred. Experience using electronic health records, authorization systems, and managed care technology platforms preferred Working knowledge of medical terminology, managed care operations, utilization management processes, prior authorization workflows, customer service and call center standards, Medicare and Medicaid programs, and HIPAA requirements is preferred

Location: University Health · TPA DCHP PHM POPULATION HEALTH MGM
Schedule: Full Time, Day Shift

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utilization management reviewer jobs in san antonio, tx

Intake Representative - CFHP

Chiropractor

Board-Certified Psychiatrist

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