Utilization Management Rep

Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical Finished Product Operator or a Polymers Packaging/Warehousing/Shipping Operator on a long-term, indefinite assignment. You will be working with chemicals and should be comfortable doing such - either with previous experience or the willingness to learn.

Responsibilities include:

• Responsible for coordinating cases for precertification and prior authorization review.
• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refers cases requiring clinical review to a Nurse reviewer.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks benefits for facility based treatment.

Job Requirements:

• Requires High school diploma/GED.
• Medical terminology training and experience in medical or insurance field.
• A minimum of 1 year of call-center experience; proficient analytical.
• Strong written and oral communication skills.
• Good computer navigation/keyboarding skills.
• Ability to multi-task, well organized, and good time management skills.

All your information will be kept confidential according to EEO guidelines.