Utilization Management Assistant 

Life and Health Division

 

As of August 18, 2023

​

Responsibilities ​

• Serves as the first line of contact on all phone Utilization Management inquiries

• Monitors and collects faxes on all incoming pre-certifications or pharmacy requests from providers

• Enters and assigns pre-certifications numbers generated by WLT system  

• Routes all pre-certifications to the UM Coordinator/Manager/ Director for review

• Prepares reports on the pre-certifications received on a weekly or monthly basis

• Responsible for the entire pre-certification safe keeping, pulling and re-filing

• Assist on any off-island care inquiries and issues with regards to appointments and authorizations

• Ensures that off-island requests have been validated and forwarded to the Utilization Manager for review

• Works with the off-island providers to help facilitate, coordinate and secure appointment schedules

• Prepares off-island “letter of authorization” for review and approval signature by the Utilization Manager

• Discusses benefits thoroughly and in detail with both members and providers

• Prepares and sends “letter of authorization” to the respective providers and/or members

• Any other job related duties as assigned by supervisor

​

Requirements

• High school diploma or equivalent required
  Prior work experience in customer service preferred

• Prior experience in office administration and medical insurance industry is preferred

• Must have excellent communication skills in verbal and written form

• Experience with Microsoft Office (ex: Outlook Express, Microsoft Word/Excel)

• Experience with operating Xerox machine (ex: Copy, Fax and Scan)

• Ability to use WLT software is preferred

• Ability to work in a fast-paced environment, handling multiple tasks, and meet established deadlines

​