United States onlyThe UM Administrative Clinical Support Staff performs a range of administrative tasks, resolves problems and may coordinate administrative support activities that require knowledge of program operations, policies, and processes. The position will be responsible for the transferring of clinical data, conduct pre-review screening of service authorization requests and ensuring administrative supports are in place to meet required departmental deadlines in accordance with contract, federal and Accreditation standards.
This position is full-time remote. Selected candidate must reside in North Carolina and available to travel for onsite meetings to the Home office (Morrisville, NC), if needed.
Responsibilities & Duties
Program Operations
- Complete the administrative function of UM Peer Review workflow by coordinating and assigning cases to qualified Peer Reviewers and notification to UM Clinical Specialist of completed Peer decisions
- Screen and schedule providers eligible for Peer-to-Peer conversations based upon pre-defined criteria
- Timely mailing and tracking of adverse decision letters to enrolled members is included in the absence of a contracted mailing vendor
- Other functions include support for high priority, time sensitive and daily procedural tasks such as: pre-screening service authorization requests and, related activities according to policies, procedures and regulatory compliance guidelines
Administrative Support Activities
- Completing data entry (intake function) for service authorization requests submitted by means other than electronic provider portal (E.g., Email, fax, phone)
- Monitor and complete intake functions for notification of inpatient admissions from NC*Notify
- Writes, edits, or coordinates the preparation of correspondence, consumer letters, reports, or other printed material according to well established standards or readily available sources
- Provides a wide range of administrative services necessary for the supervisor to accomplish their work and for program operations
- Transferring of clinical information to facilitate Peer Review of Services; monitoring staff activities related to commitments made by the supervisor
- Manages administrative records using existing procedures or proposing new methods as necessary
- Respond to providers and external customer inquiries related to the status of an authorization and UM operational procedures. Response time must be consistent with contractual and accreditation standards detailed in Policy and Procedures
Minimum Requirements
Education & Experience
High School diploma and four years of related work experience; or an equivalent combination of education and experience that provide the essential knowledge and abilities to perform the job.
Knowledge, Skills, & Abilities
- Knowledge of office management, including the ability to organize workflow and coordinate activities among department staff
- Ability to do calculation, summarize, compile and tabulate numerical material
- Ability to maintain work standards of programs activities and ability to analyze and correct errors
- Ability to maintain an effective working relationship with other employees and the public
- Proficiency with databases and the ability to navigate through SharePoint
- Knowledge of NC Tracks & Alliance Medical Records electronic system
- Ability to collaborate with multi-departmental and multi-unit teams
- Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required
