Non-Clinical Intake

Triage all incoming calls into the Utilization Management Unit, enter referrals into the system, and request clinical information while forwarding referrals requiring medical necessity determinations to clinical staff. Support claim-related provider appeals by reviewing referrals for completeness, verifying eligibility and network status, and assisting with new hospital admissions. Respond to telephonic requests for authorization and benefit coverage, approve services based on benefit packages, and perform data entry for specialty visits, rehabilitation, and DME. Identify service requests outside member benefit packages and refer them to clinical staff, maintaining confidentiality of member records. Act as a preceptor to new staff and perform other duties as assigned.