Address
Form of workWe are looking for an Intake Specialist II to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/
Position Summary:
Responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case managers. Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Monitors member's utilization patterns for identification of high risk and under and overuse of services. Clarifies benefits for providers. Works to resolve complex authorization issues and serves as a resource to non-clinical staff.
This position is fully remote.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
Qualifications:
Required:
- High school diploma or equivalent.
- One (1) year experience working for a health plan in Care Management Programming and able to demonstrate 75% proficiency in all authorization categories and processes for all lines of business.
- Two (2) years' experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting and completion of a medical-related training program such as Medical Assistant, EMT, or Nursing Assistant, or
- Three (3) years' experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting
Preferred:
- Two (2) years Managed Care Utilization review experience
- Experience and knowledge of the preauthorization process for medical services
- Health care related certification i.e. CNA, CPB, CPC, Medical Assistant
- Associate degree in a business or health care
- Physician office experience
- Experience and knowledge of Medicare, HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, claims processing, membership/eligibility)
