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FULLY REMOTE JOB OPENING. You will have to train onsite for the first 3 weeks, then you will switch to working fully remote from home after that point.

Description:

The case review specialist is responsible for performing all tasks relevant to in-house communications with the patient/client, referral source, and verification of eligibility, co-pay and coordination of setup with Northwood providers. In addition, this person is part of the investigative team that researches product and member special needs. The Case Review Specialist conducts the initial screening for service requests, adds the collection and transfer of non-clinical data to the case, conducts acquisition of structured clinical data, and activities that do not require evaluation or interpretation of clinical information. The non-clinical staff is not responsible for conducting any UM review activities that require interpretation of clinical information including non-certification of requests. Case review is not on the phones, as much. They will read and write for investigation to see if a member does or does not qualify. Reading through medical policies, healthcare documents, scripts, medical records and from the Medicare Plan. They will write up a case on why or why not the person qualifies. It is more in depth from traditional customer service.

• Answer incoming phone calls and input customer requests for equipment according to the health plan criteria and diagnosis.

• Maintain open line of communication with patients/clients, and referral sources

• Respond to patient/client questions and problems.

• On-line set-up of new patient/client files, verifying eligibility information and co-pays

• Verification of PCP involvement in ordering equipment

• Review of members address and telephone number for delivery

• Reviews on-line order for completeness and accuracy before faxing order to Northwood provider for set-up

• Data entry in the Northwood case review data base

• Investigate products, providers, prices and medical policies on equipment for guest members and traveling members.

• Works with Utilization Management Nurse Manager/clinical staff on cases where clinical judgment is required.

• Utilizes automated or semi automated processes to collect data or conduct initial screening of cases following Health Plan guidelines

  Hours of operation and breaks: 8:30-5pm with 45 min lunch. Fully remote after 3 weeks of training onsite in Madison Heights, MI.

Additional Skills & Qualifications:

• Need at least 1+ year of experience working in healthcare, ideally within case review, customer service, prior authorization, or claims.

• Completed high school diploma or GED.

  About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

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.