HAMR-UM Intake Rep Pr Auth

Carle Health
United States, Illinois, Champaign
3310 Fields South Drive (Show on map)
Feb 14, 2025
Overview The Utilization Management Intake Coordination Representative is responsible for providing assistance with, and coordination of utilization management operational functions. The Intake Coordination Rep is the initial phone or digital contact to greet all customers professionally and provide accurate information about the status of preauthorization requests (inpatient or outpatient). Works as an integral part of the designated team. Responsible for reviewing initial authorization requests, manual data entry as needed, and coordinating operational functions for utilization management decisions. As part of this process, communicates with staff at provider offices, approves services based on established guidelines, accesses electronic medical records, assist Nurse Coordinators with requests for more clinical information or research into available network provider options. Physically prepares and mails member and provider letters pertaining to UM operations in accordance with established Accreditation and Regulatory standards. Qualifications Successful completion of Medical Terminology. within 1 Year Experience Requirements Two (2) years General - Customer Service, Medical office, or health insurance experience. Previous public contact or customer service experience. Previous experience operating office equipment: i.e., computers, PCs, copy machine, fax machine, word processing applications. Responsibilities Specialized Knowledge and Skills Requirements Ability to plan, prioritize, and complete tasks under stress with frequent interruptions. Demonstrates an aptitude for data management and information systems, financial applications, and administrative planning. Ability to handle high-volume digital and telephone work. Must be able to work independently on a daily basis, as well as part of the Health Alliance team. Ability to change and adapt daily to the changes in the managed care environment and products. Excellent communication, organization, computer literacy, and time management skills required. Essential Standard Job Function Essential Functions Provides accurate, pertinent information to incoming department communication and appropriately distributes other communication to the most fitting departmental or organizational resource in a timely manner. Performs all preparatory aspects of the utilization management processes within the scope of responsibility. Performs selected authorization functions under the supervision of an RN, following department policy and procedure, and forwards the balance to appropriate department resources. Receives and/or collects member information, performs detailed investigation of comprehensive member and clinical status information, and disseminates the information to responsible departmental parties. Documents all communication regarding member activity in the electronic system concisely and clearly, based on standardized department guidelines. Responsible for physically printing, preparing, and mailing UM communications at the Carle at the Fields location as required. About Us Find it here. Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. \| For more information: human.resources@carle.com. Compensation and Benefits The compensation range for this position is $16.73per hour - $27.1per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.