Temp - Non-Clinical - Intake Specialist (Days) ...

Position Summary:Responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case managers. Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting.Monitors member's utilization patterns for identification of high risk and under and overuse of services.Clarifies benefits for providers. Works to resolve complex authorization issues and serves as a resourceto non-clinical staff.Essential Functions and Responsibilities:1. Intake and processing complex authorizations for outpatient medical services for assignedproduct line(s).2. Intake and processing of authorization of inpatient facility admissions for assigned product line(s),including concurrent review to facilitate discharge planning.3. Processing and repair of authorization issues in the workbasket.4. Processes appeal determinations to include appropriate documentation and provide disposition toappealing entity.5. Serves as a resource and provides training as required for non-clinical staff.6. Reviews all utilization for most cost-effective delivery.7. Monitors members utilization patterns.8. Serves as a liaison between the Plan and providers to resolve referral issues, as directed9. Processes follow-up calls to members for identified mailings to meet policies and regulatoryguidelines as required.10. Initiates review process under leadership direction.11. Supports the network providers through education and periodic contacts as directed12. Assist Members and Providers with questions and concerns regarding member care needs.13. Other duties as assigned or when necessary to maintain efficient operations of the departmentand the Company as a whole.*** This is a 56% markup need. Contractors need to make a facility mandated #### per hour ***Requirement description : Required:High school diploma or equivalent.One (1) year experience working for a health plan in Care Management Programming and able todemonst####5% proficiency in all authorization categories and processes for all lines of business. Two (2) years' experience working in a medical practice office, an urgent care, hospital, skille nursing facility or other health care setting and completion of a medical-related training program such as Medical Assistant, EMT, or Nursing Assistant, orThree (3) years' experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care settingPreferred: Two (2) years Managed Care Utilization review experience Experience and knowledge of the preauthorization process for medical services Health care related certification i.e. CNA, CPB, CPC, Medical AssistantAssociate degree in a business or health careUtilization Intake Spec II Job Description Page 2 of 2Effective: 06/01/2021Physician office experienceExperience and knowledge of Medicare, HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, claims processing, membership/eligibility)This is a 56% markup need. Contractors need to make a facility mandated #### per hour

Created: 2026-04-02