We are currently hiring for the

Maryland Behavioral Health Administrative Services Project!

ATHENA Consulting is an award-winning staffing firm serving state and local governments. Our mission is to make lives better! We make our Clients’ Lives Easier by engaging and supporting our clients and partnering with them to be the most knowledgeable staffing partner. We make our Employees’ Lives Better by identifying and cultivating their talents and matching these talents with our customers’ needs. ATHENA places a high value on customer service, accountability and getting the job done.

POSITION SUMMARY:

This FULL-TIME position ranges from $17.00 per hour depending on experience and is in Hanover, MD. The Utilization Management Rep Il is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions, and related duties as assigned.

This position is remote. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Managing incoming calls or incoming post services claims work.  


• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.  


• Obtains intake (demographic) information from caller. 


• Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given. 


• Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. 


• Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. 


• Verifies benefits and/or eligibility information. 


• May act as liaison between Medical Management and internal departments. 


• Responds to telephone and written inquiries from clients, providers and in-house departments. 


• Conducts clinical screening process


• Participate in developing department goals, objectives, and systems


• Participate in staff meetings and attend other meetings and seminars as assigned.


• Recommend new approaches, policies, and procedures, to continually improve efficiency of the department and services performed.


• Efficiently performs duties as assigned and works as a team within division and company.


• Perform other related duties as assigned.

Required Skills/Abilities:

• Excellent verbal, written, and listening communication skills within the English language.


• Proven, high quality customer service (internal and external customers).


• Ability to work collaboratively.


• Solid ability to analyze situations carefully and adopt appropriate courses of action.


• Ability to understand and adhere to the duties, methods, and procedures required by the position.


• Excellent organizational skills and attention to detail.


• Ability to prioritize tasks.


• Ability to effectively communicate to large and small group audiences.


• Proficient with Microsoft Office Suite or related software.

EDUCATION/EXPERIENCE REQUIREMENTS:

• Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.  


• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Certain contracts require a Master's degree.

Physical Requirements:

• Possible prolonged periods of sitting at a desk and working on a computer.


• Must be able to lift and move up to 25 pounds at times.


• Standard hours of work Monday through Friday, 8:00 am – 6:00 pm.

Successful ATHENA employees will display the following characteristics:

• You strive to be the best in your field currently and in the future.


• You like to make your employer look good.


• You find solutions, where others only see problems.


• You are proactive, you make and meet commitments, and you perform your duties exceedingly well.


• You are aware of the employer’s needs at all times and are well-versed in what you personally and ATHENA can offer them as a whole.


• You have the ability to work with diverse, integrated, deliverable-driven teams to accomplish the larger mission.

The statements in this Job Posting are intended to describe the general nature and minimum level of work required. The content should not be construed as a complete list of all duties, responsibilities, and skills required to meet the criteria for this position. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Application for employment is not intended to and does not create a contract or offer of employment and if hired, employment with the company is on an at-will basis and could be terminated at the will of either party.

ATHENA Consulting LLC does not discriminate in hiring based on federally protected classifications to include but not limited to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, marital status or other characteristics protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.