Utilization Review Specialist

<b>At LogistiCare, you have the ability to define your own career journey and enjoy the ride along the way and make possibilities real. Your growth is our objective. Whatever your passion, you’ll have the opportunity to find the career you’re looking for, learn and grow in your role, and make a difference in the lives of others. And you’ll do it alongside colleagues you can count on, in a vibrant work environment, with leadership that puts you first. <br/><br/>Sound like a good career fit? </b>

Norton, VA


<strong><a href="http://www.logisticare.com/" target="_blank" rel="noopener noreferrer">Who We Are: Transportation &amp; Integrated Health Services</a><br /></strong>Nation&rsquo;s largest manager of non-emergency medical transportation, provides 69+ million rides annually in 39 states and D.C. Supports integrated health care programs, improving care coordination for members and their corresponding providers and hospital networks.<br /><br /><strong>What We Value Most &ndash; YOU<br /><br />Benefits - The Whole Package&nbsp;</strong><br />Medical, Vision, Dental, Disability, EAP, Legal, Voluntary Life Insurance, Group Life &amp; AD&amp;D, Flexible Spend Account, Paid STD &amp; LTD, Vacation &amp; Holidays<br /><br /><strong>Culture - Why You Want to Come to Work Every Day</strong><br />Casual Dress - Business Casual, Relaxing - Comfy Lounge Areas, Excitement -Themed&nbsp; Luncheons, Great Hours &amp; Set Shifts - (Mon. &ndash; Fri.)<br /><br /><strong>View Featured Positions Below OR Check Out <a href="https://recruiting.adp.com/srccar/public/RTI.home?c=2153313&amp;d=ExternalCareerSite" target="_blank" rel="noopener noreferrer">All&nbsp;Career Journey Opportunities&nbsp;with LogistCare</a></strong> http://www.logisticare.com/

keywords: about,medical,reporting,transportation,physical demands,communication,culture,education,skills,experience


Overview: The Utilization Review Specialist is responsible for managing member utilization.
Responsibilities: <ul> <li>Determines member eligibility Verifies the appropriateness of service levels Manages the denial and appeal process</li> <li>Manages Transportation Provider Liquidated Damages</li> <li>Monitors exceptional distance report Confirms utilization of the closest medical provider of services</li> <li>Assists with standing order re-certification</li> <li>Audits whether provider billed for previously cancelled trips and/or was paid for trips that did not occur Performs other duties as assigned</li> </ul>
Requirements: <ul> <li>Ability to communicate effectively with others using the spoken word Communication, Written</li> <li>Ability to communicate in writing clearly and concisely Decision Making</li> <li>Ability to make critical decisions while following company procedures Interpersonal</li> <li>Ability to get along well with a variety of personalities and individuals Problem Solving&nbsp;</li> <li>Ability to find a solution for or to deal proactively with work-related problems</li> <li>Ability to find a solution for or to deal with customers and co-workers</li> </ul> <br /><br /><strong>Education</strong><br /> <ul> <li>High School Graduate or General Education Degree (GED) required</li> </ul> <br /><br /><strong>Experience</strong><br /> <ul> <li>Prior experience in a medical office preferred; social services or case management experience is a plus</li> </ul> <br /><br /><strong>Skills and Abilities</strong><br /> <ul> <li>Superior customer service and phone skills</li> <li>Strong verbal communication, writing, problem solving, time management, and organizational skills</li> <li>Must possess professional writing skills and ability to correspond with professionals both verbally and in writing</li> <li>Ability to type 35 corrected words per minute</li> <li>Must have strong spreadsheet and database skills to include high level proficiency with (Microsoft Excel, Word and Outlook)</li> </ul> <br /><br /><strong>SUPERVISORY RESPONSIBILITIES<br /></strong> <ul> <li>None</li> </ul> <br /><br /><strong>PHYSICAL DEMANDS</strong> <br /> <ul> <li>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.</li> <li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li> <li>While performing the duties of this Job, the employee is regularly required to talk or hear.</li> <li>The employee is frequently required to use hands to finger, handle, or feel.</li> <li>The employee is occasionally required to stand, walk, reach with hands and arms and lift.</li> <li>Specific vision abilities required by this job include close vision.</li> </ul> <br /><br /><strong>WORK ENVIRONMENT</strong> <br /> <ul> <li>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.</li> <li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li> <li>Entire work time is conducted in an office environment in a controlled atmosphere building.</li> <li>The noise level in the work environment is usually moderate.</li> <li>This job specification should not be construed to imply that these requirements are the exclusive standards of the position. Incumbents will follow any other instructions and perform other related duties as may be required by their supervisor.&nbsp;</li> </ul>