Utilization Management Medical Assistant

Job description

WelbeHealth PACE helps seniors stay in their homes and communities by providing medical care and community-based services. We believe in going the extra mile and aim to make a genuine difference in our participants’ lives. The Utilization Management Medical Assistant (UM MA) is accountable for the review and audit of authorization requests to ensure services are authorized and meet standard medical guidelines. Ensuring that the right care is done in the right place at the right time is a critical aspect of this role. The UM MA is also accountable for supporting the organization’s UM program through close auditing of participants’ charts and authorization requests. This role requires strong working knowledge of UM regulatory and documentation standards. Essential Job Duties: - Conduct review of consult summaries, imaging results, procedure summaries, and more, to determine if additional follow up services are requested - Enter orders on behalf of PCP or ordering provider, based on PCP direction and consult summaries from external providers - Manage departmental clinical inboxes, email inboxes, and fax queues to ensure appropriate handling of documents and authorization requests - Wo...