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RESPONSIBILITIES

I. JOB SUMMARY/RESPONSIBILITIES:

• Coordinates and maintains the utilization review process for clinical services including medical, surgical and behavioral health services at the Queen Emma Clinics (QEC).

• Performs duties and responsibilities in accordance with utilization tracking and prior authorization procedures.

• Assists with coordinating and generating referrals for services provided outside of the Queen Emma Clinics.

II. TYPICAL PHYSICAL DEMANDS:

• Essential: sitting, finger dexterity, seeing, hearing, speaking

• Continuous: sitting, finger dexterity, seeing, hearing, speaking

• Occasional: walking, stooping/bending, twisting body, lifting, pushing/pulling and carrying usual weight of 1 pound up to 5 pounds, reaching above, at and below shoulder, repetitive arm/hand motions, static gripping of an object.

• Operates a computer and telephone.

III. TYPICAL WORKING CONDITIONS:

• Not substantially subjected to adverse environmental conditions.

IV. MINIMUM QUALIFICATIONS:

A. EDUCATION/CERTIFICATION AND LICENSURE:

• High school diploma or equivalent.

• Medical terminology required; anatomy and physiology preferred.

• Graduate of a Medical Assistant program preferred

B. EXPERIENCE:

• Two (2) years healthcare experience in patient care or other health related fields such as patient registration, scheduling, business services, etc.

• Experience to demonstrate knowledge of computers for word processing, spreadsheets, dictations.

• Knowledge of healthcare insurance, CPT and ICD coding.

• Prior experience with Electronic Medical record system and ability to navigate and review documentation preferred.

Equal Opportunity Employer/Disability/Vet