Cascade Comprehensive Care Inc Hiring for Utilization Review Analyst – Part time – Flexible hours at Remote Full Time

Only applicants from Oregon, Washington or Colorado will be considered.

SUMMARY
This position is responsible for processing prior authorization requests for members on the Oregon Health Plan by performing the following duties.

JOB DUTIES

• Determines eligibility and benefits of members.
• Uses Oregon Health Plan prioritized list and criteria sets in order to make coverage determinations.
• Determines appropriate level of care and cost effectiveness of services provided to the member.
• Appropriately refers to Medical Director for review of authorizations if standard criteria are not met.
• Documents authorization review which includes requests, evaluations, and decisions (RED).
• Coordinates with Primary Care Physician (PCP), specialist, and other community resources involved in the care of the member.
• Maintains a positive working relationship with other agencies and providers including out of area.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
• Respectfully takes direction from manager.

EDUCATION and/or EXPERIENCE
High school diploma or general education degree (GED) and two to four years related experience and/or training. Knowledge and understanding of medical coding, medical abbreviations, and medical terminology is preferred.

COMPUTER SKILLS
Job requires specialized computer skills. Must be adept at using various applications including spreadsheet, report writing, graphics, word processing, communicate by e-mail and use scheduling software.

CERTIFICATES, LICENSES, REGISTRATIONS
LPN or Certified Coder is preferred.

This is a part time position up to 24 hours per week. Hours are flexible and can be done any day or time of the week including weekends once trained.To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.

Job Type: Part-time

Pay: From $1.00 per hour

Benefits:

• 401(k)
• 401(k) matching

Schedule:

• Day shift
• Night shift
• On call
• Weekend availability

Work Location: Remote