Lead Utilization Management team with full technical responsibility for team output.Provide overall direction and management for a care management intake group.Ensure performance standards are met.Focuses on ensuring short-term outcomes and effectiveness of team integration with other work areas.Provide input into workforce planning and recruitment activities.Conduct audits and analyze results to improve the quality of service.Serve as the department's workflow expert.SME and testing to ensure MHK workflow.

Provide training, feedback, and case corrections for team members.Assisting with workflow and process improvement in MHK.Receive authorization requests from hospitals, providers, and members; Meet service level goals (e.g., Grade of service, Average Handle Time, Average Speed to Answer, abandonment rate).Determine authorization requirements based on company policy, member benefit grid, and provider status.Review authorization requests and make determinations on the correct authorization process.Provide determinations on authorization requests to members and providers based on benchmark standards for authorization decisions—process extensions of authorizations as appropriate.Maintain benchmark standards for Turn Around Time (TAT) as established by the organization.

Obtained and input accurate registration data, such as patient demographics, insurance information and clinical data.Evaluated patients' medical records referred for treatment to determine appropriateness for admission.Received and coordinated all referrals to include notification of insurance for prior authorization and services covered.Reviewed referrals and verified all physicians' information.

Facilitated timely and appropriated assignment of patients to clinicians, including nurses, physical therapists, occupational therapists, medical social workers and dieticians.Supported efficient workflow in collaboration with the intake department and all other disciplines.Scheduled nurses to do admissions and resumptions of care to continue with the care of the patients.

Contributed toward meeting business objectives through prompt, accurate inputting of claims including retrieval of necessary policy information.Provided customer service support for team members by completing routine letters for data gathering, customer acknowledgements, and routine diary set up.Served as the point person for management of medical record gathering by carrying through on medical development in assessing claim outcomes.Experience with Electronic Medical Records Systems.Processed and paid invoices.