Job Description

We are searching for a Utilization Management Assistant- Someone who receives, processes and completes data entry of demographic information on all referral/authorization requests from participating providers via fax or phone. Assists and collaborates with all medical management staff, as well as other health plan staff, e.g. Claims Department, Network Development. Provides customer service and education for all incoming calls regarding provider and/or product information.

Think you've got what it takes?

Qualifications:

• H.S. Diploma or GED required
• 2 years managed care, preferably in medical management department, claims and member service preferred
• Experience in Healthcare or Insurance environment preferred

Responsibilities:

• Serves as support to Medical Management Intake Department
• Eligibility Confirmation
• Provider/Member Education
• Internal Collaboration
• Managed care, preferably in medical management department, claims and member service background helpful.
• Health care setting employment a plus.
• Utilizes resources available from TCHP or State Agencies. Reference may be made by phone or online. Dates must be referenced prior to authorizations.

About Us

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.