Utilization Management Review Assistant (Remote Within State of California)

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra is looking for a Utilization Management Review Assistant to join our growing team.

As a Utilization Management Review Assistant, you will play a crucial role in optimizing the clinical review process by meticulously preparing prior authorization cases. You will be instrumental in ensuring that all cases align with our internal policies, procedures, and services, maintaining the highest standards of accuracy and compliance. Your keen attention to detail and commitment to efficiency will be vital in driving the success of our review operations and enhancing overall organizational effectiveness.

Job Responsibilities:

• Provide primary non-clinical program support, including provider training, customer service, call triaging, authorization preparation, data entry, and tracking functions for both members and providers.
• Offer non-clinical assistance to other programs as needed, demonstrating flexibility and adaptability in meeting organizational requirements.
• Review patient records for completeness, identifying cases that require additional non-clinical information to meet submission requirements.
• Process and document case discharges with accuracy and timeliness.
• Ensure the prompt and precise submission of all administrative documents to the appropriate parties.
• Serve as a liaison with internal and external customers, fostering positive and professional relationships to facilitate an efficient review process.
• Attend training sessions and scheduled meetings to stay informed and up-to-date on case preparation requirements.
• Uphold the confidentiality of medical records by using computer passwords and secured files appropriately, in compliance with HIPAA policies.
• Answer calls with proper telephone etiquette and communication skills, in line with Acentra Health's policies, procedures, and guidelines.
• Cross-train to perform duties for other contracts within the Acentra Health network, contributing to a flexible workforce that meets client and consumer needs.
• The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary.

Required Qualifications/Experience and Knowledge

• High school diploma or GED required; Associate degree preferred, or equivalent work experience in medical, behavioral, or social/support settings.
• Minumum 1 - 2 years of experience in administrative or in health care records management capacity.
• Minumum 2 - 3 years in administrative support or customer service, within healthcare.
• Strong understanding of office environments, business processes, and customer service approaches tailored to medical provider stakeholders.
• Familiarity with government structures and related programs is advantageous.
• Excellent communication skills, with the ability to multitask, prioritize, and serve a diverse range of customers.
• Experience in development and project activities, as well as staff and provider training; public speaking skills are preferred.
• Previous experience and knowledge of California Medicaid and Medicaid processes, including handling related procedures, is preferred.
• Proactive in assessing office functions and reporting potential issues to the Director.
• Ability to track and report provider issues appropriately.
• Willingness to learn the Atrezzo application and assist customers with technical issues related to Health Homes authorization requests.
• Proficiency in Microsoft Office applications, particularly Excel, to ensure efficient use of essential software tools.

Why us

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner t