Utilization Management Asst, Team Lead

2 weeks ago

Houston, United States Texas Children's Hospital Full time
Job Description

We're looking for a Utilization Management Assistant, Team Lead, someone who's ready to grow with our company. In this position you will provide leadership support and oversight of daily inventory of cases/authorizations and UM processes to ensure compliance. Provide assistance or information regarding member and provider needs regarding Utilization Management (UM) authorizations to staff members, interdepartmental teams, and leadership. Supports the Intake UM process which encompasses staff receiving, processing, and completing data entry of demographic information on all referral/authorization requests from providers. Assists and collaborates with all medical management and other health plan staff. Provides customer service and education for all incoming communication regarding provider and/or authorization information.

Think you've got what it takes?

Skills & Requirements
  • Associate's degree in healthcare administration or business Administration required
  • Bachelor's degree in healthcare administration or business Administration preferred
  • 2 years of Managed Care Experience required
  • 2 years of Utilization Management/Utilization Review Experience required


Job Duties & Responsibilities

Supports the Utilization Management Department's Daily Operations.

Primarily responsible for processing initial incoming faxes or phone requests into the intake department.

Gathering demographic and benefit data documenting in appropriate system. Determined by policy and procedures.

Adhere to time frames and turnaround times.

Route and evaluate all faxes and CRMs to refer and assign as necessary to other staff and departments.

Implement nuances of product line and regulatory requirements in the processing of all authorization requests.

Conducts initial and on-going system training for UM Staff.

Serves as an informal workforce leader.

Participates in quality initiatives and performance management.

About Us

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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