Responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers, And assisting in training other internal departments in medical management processes and policies.
MAJOR JOB DUTIES AND RESPONSIBILITIES:
Primary duties may include, but are not limited to: Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). Conducts initial review of files to determine appropriate action required. Responds to requests, calls or correspondence within scope. Provides general program information to members and providers as requested. May review and assist with cases. Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. May assist with case referral process. Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
- Requires a high school diploma
- 3 years experience in an insurance environment
- 3 years of administrative and customer service experience with knowledge of managed care or Medicare concepts or any combination of education and experience which would provide an equivalent background.
- Good computer skills
- Excellent communication skills
• High School Diploma/GED/AA Degree
• Preferred one (1) year of experience
• Ability to work with moderate to limited supervision; ability to follow instructions and be detail oriented
• Successful completion of Maxim background screening and hiring process.
• Successfully pass all Maxim screening exams.
• Current physical exam, if required by state regulations or contract specifications
• Current TB test or Chest X-Ray
Maxim employees are our greatest asset. We offer the following benefits:
-Medical, Dental, Vision, and Life Insurance
-Positive Work Environment and Friendly Staff Bonuses
-Travel Benefits (as applicable)
-24 hour on- call service
Since 1988, Maxim Healthcare Services has become one of the largest employers of clinicians in the nation. At Maxim Staffing Solutions, a division of Maxim Healthcare Services, we’re known for our quality of patient care, commitment to employee development and emphasis on customer service. Maxim knows that you deserve great benefits, flexible scheduling and rewarding assignments, so our Healthcare Recruiters will match your skills, experience and schedule in order to find you the best assignments in top medical facilities. Maxim Recruiters are always available to provide you with the assistance you need to get your job done, so call us today; Maxim has a solution for you.
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