Utilization Mgmt Speech Spec
Job Description
| Skills: | • Knowledge of normal and abnormal development, anatomy and physiology of the speech/swallowing mechanism, types of disorders and their etiologies, diagnostic procedures, and treatment procedures. | ||
Job Requirements
2 years professional speech-language pathology and/or utilization management experience.
• Utilizes established criteria to appropriately certify requested services within established timeframe required.
• Consults with physicians and therapists regarding patient’s history and current care needs on and ongoing basis.
• Refers case failing medical necessity criteria to the medical director or designee for review and disposition.
• Telephonic preauthorization review, and telephonic concurrent review.
• Provides discharge planning options supporting community services and caretaker participation the coordination of the continuum of care.
• Conducts timely entry of information into systems and assign appropriate length of service per established guidelines, and communicate authorization numbers to providers and member.
• Evaluates benefit coverage and regulatory guidelines pertinent to decision making.
| Education |
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Additional Information
Remote, but onsite for special trainings, meetings, or events