Bilingual Utilization Representative

Location: Los Angeles, CA
Date Posted: 02-01-2019
CareNational
Bilingual Utilization Representative - Health Plan
Los Angeles (East of downtown)
 
*** This is a Full-Time, Benefits Available, CONTRACT opportunity, expected to last 3 months, or longer! ***
** Must be fully Bilingual in English & Spanish! **
 
Bilingual Utilization Rep Job Summary: 
  • The role of the Member Utilization Representative is to assist Utilization Review nurses by screening Prior Authorization and coordination of specialized services requests, including a broad range of requests for inpatient, outpatient and ancillary services.  
  • The purpose of the Prior-Authorization, or Pre-Certification, process is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to Prior Authorization requests. 
  • The Prior Authorizations Specialist is essential to ensuring that prior authorization requests are completed in a timely fashion to meet contractual requirements. 
  • Maintains current knowledge of network resources for linking member and provider needs.  
  • Authorizes certain specified services, under the supervision of the manager and according to established departmental guidelines.
  • Per standard workflows, forwards specified requests to the clinician for review and processing.  
  • Additionally, the Specialist answers inbound calls from providers and other departments and redirects, as needed.
 
Bilingual Utilization Rep Background: 
 
  • Requires an education level of at least a high school diploma or GED.
  • 1-2 years customer service experience.
  • Strongly prefer around 1 year experience in a call center setting or phone support role.
  • Any healthcare experience is a plus.
  • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
  • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
  • Must test at a minimum of 35 wpm typing with a high level of accuracy.
  • Basic computer literacy (MS Office) and typing skills are necessary.
  • Bilingual (English/Spanish) speakers are required.


  #ADMIN
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KEVIN SLAFKOSKY
DIVISION VICE PRESIDENT
CareNational
kevin@carenational.com
410.885.4745 (CALL – TEXT – FAX)

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