Job DescriptionJob #: 1026826
Location: 5 Penn Centre West Pittsburgh, PA 15205
Schedule: Monday to Friday 8AM-5PM.
Summary: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
- Initiate authorization requests for output or input services in keeping with the prior authorization list.
- Research claims inquiry specific to the department and responsibility.
- Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
- Assess and monitor inpatient census.
- Screen for eligibility and benefits.
- Identify members without a PCP and refer to Member Services.
- Screen members by priority for case management (CM) assessment.
- Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
- Coordinate services with community based organizations.
- Attend marketing and outreach meetings as directed to represent the plan.
- Produces and mails routine CM letters and program educational material.
- Data enter assessments and authorizations into the system
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Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178.