UM Specialist II Job in Columbus 43085, Ohio US
POSITION SUMMARY:
The Utilization Management Specialist II Responsible for eligibility and benefit verification and collection of medical data needed to perform care management activities. Functions as a member of a multidisciplinary team to perform assessments, offer telephonic support for members enrolled in care management, perform activities to identify over or under utilization, assist members with healthcare navigation and identify barriers to receipt of optimal healthcare. Serves as a resource for other licensed and non-licensed UM staff. Assists the Care Management Team in delivery of high quality, cost effective health care services for Molina members.
DUTIES AND RESPONSIBILITIES:
- Maintains familiarity with plan benefits.
- Demonstrates the ability to apply critical thinking and independent judgment skills.
- Provides excellent customer service (including internal and external customers) to ensure excellent service to our members and physicians in all aspect of their medical care delivery
- Adheres to departmental standards of confidentiality of medical and proprietary information.
- Participates in continuous quality improvement activities including participation in meetings as an active member of the Multidisciplinary Team.
- Meets attendance guidelines per Molina Healthcare policy.
- Follows “Standards of Conduct” guidelines as described in Molina Healthcare HR policy 2.0.
KNOWLEDGE, SKILLS AND ABILITIES
- Ability to think analytically to problem solve.
- Good communication and interpersonal skills.
- Must be professional and diplomatic.
- Must have a high regard for confidential information.
- Ability to type 65 WPM and have 10-key experience.
- PC experience in Windows environment.
- Excellent verbal and written communication skills
- Ability to abide by Molina’s policies
- Maintain regular attendance based on agreed-upon schedule
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Other duties as assigned
Required Experience:
Minimum three years acute care clinical experience and or managed care UM experience combined
Required Licensure/Certification:
Current Ohio LPN, or RN license/certification in good standing
Molina Healthcare is an Equal Opportunity Employer (EOE). M/F/V/D