*Description:*Summary: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Job Responsibilities: 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 members 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. *Top Skills Details:*healthcare industry,member service,medical record,insurance benefits About Aston Carter: At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit [AstonCarter.com.](AstonCarter.com) Aston Carter is a company within Allegis Group, a global leader in talent solutions.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call
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) for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
- Long Term Care
- Disability Insurance
- Nursing Homes
- Senior Living