Utilization Review Specialist

<p>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&rsquo;ll have the opportunity to find the career you&rsquo;re looking for, learn and grow in your role, and make a difference in the lives of others. And you&rsquo;ll do it alongside colleagues you can count on, in a vibrant work environment, with leadership that puts you first.</p> <p>Sound like a good career fit?</p>

Charleston, WV


<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>NOW HIRING CUSTOMER SERVICE REPS!!</strong> <br />CSR Days │ CSR Nights/Weekends │CSR Bilingual&nbsp; http://www.logisticare.com/

keywords: environment,analysis,medical,compliance,audit,communication,experience,database,education,professional


Overview: The Utilization Review Specialist is responsible for managing member utilization<br /><br />Environmental and Working Conditions:<br /> <ul> <li>Entire work time is conducted in an office setting</li> </ul>
Responsibilities: Essential Duties and Responsibilities:<br /> <ul> <li>Determines member eligibility</li> <li>Verifies the appropriateness of service levels</li> <li>Manages the denial and appeal process</li> <li>Monitors exceptional distance report</li> <li>Confirms utilization of the closest medical provider of services</li> <li>Assists with standing order recertification</li> <li>Audits whether provider billed for previously cancelled trips and/or was paid for trips that did not occur</li> <li>Performs other duties as assigned</li> </ul>
Requirements: POSITION QUALIFICATIONS<br />Competency Statement(s)<br /> <ul> <li>Communication, Oral - Ability to communicate effectively with others using the spoken word</li> <li>Communication, Written - Ability to communicate in writing clearly and concisely</li> <li>Decision Making - Ability to make critical decisions while following company procedures</li> <li>Interpersonal - Ability to get along well with a variety of personalities and individuals</li> <li>Problem Solving -- Ability to find a solution for or to deal proactively with work-related problems</li> <li>Relationship Building -- Ability to find a solution for or to deal with customers and co-workers</li> </ul> Education<br /> <ul> <li>High School Graduate or General Education Degree (GED) required</li> </ul> Experience:<br /> <ul> <li>Prior experience in medical office, social service or case management</li> <li>experience a plus.</li> </ul> Skills:<br /> <ul> <li>Superior customer service and phone skills; 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 accurately type 35 words per minute</li> <li>Must have strong spreadsheet and database skills to include intermediate proficiency with Microsoft Excel, Word and Outlook)</li> </ul> Physical and Mental Requirements:<br /> <ul> <li>Must be able to understand and follow complex instructions</li> </ul>