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Utilization Review Coordinator

CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE:
To assign workers compensation utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Accesses, screens and assigns cases for utilization review (UR).
Provides accurate information to callers based on customer requests; triages telephone calls between UR, triage and other departments.
Enters demographics and UR information into claims or clinical management system accurately; maintains data integrity; obtains statistics for record keeping; and provides reports as needed.
Supports clinical staff through completion of UR process.
Obtains all necessary information required for UR process from internal and external sources per policies and procedures.
Directs injured workers, employers and claims examiners into PPO network for treatment.
Confirms receipt of forms and filings required by regulatory agencies; distributes incoming and outgoing correspondence, faxes, mail and copies; uploads review documents to paperless system.
Supports other units as needed.
Supports the total performance management initiative.

QUALIFICATIONS

Education & Licensing
High School diploma or GED required.

Experience
One (1) year of administrative experience and six (6) months customer service experience required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.

Skills & Knowledge
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Detail Oriented
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/20900703

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Published on Aug 16, 2011
Viewed: 284 times