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ACCESS REPRESENTATIVE II - UTILIZATION REVIEW in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 12/26/2018

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.
The ideal Access Representative will have strong data entry skills and working knowledge of Epic. This will be at our business services offices near Rancho Bernardo with plenty of amenities on the premises, and close to shopping and housing in the North County area.
The Access Representative II is responsible for working assigned queues, including making review determinations for referrals/authorizations on internal criteria list level. Responsible for preparation of authorization requests for internal RN review or external Health Plan review including obtaining appropriate medical records, Health Plan/Milliman criteria, benefit coverage information and forwarding to the appropriate reviewer. Enter review decisions in EPIC. Act as a resource for referral/authorization questions from Health Plans and clinic staff.
This position is Full-Time, 8 hour DAY shifts, Monday-Friday - Located in our Rancho Bernardo office.

Job Requirements

Required Experience/Specialized Skills:
  • Minimum of 3 years experience in a managed care setting preferably in utilization review
  • Working knowledge of Word, EXCEL, and Internet
  • Familiarity with medical terminology and coding  
  • Strong organizational skills. High level of independence and problem solving skills
Required Education/Course(s)/Training:
  • High School Diploma.
Preferred Experience/Skills:
  • College or vocational class completion in medical terminology and coding classes
  • Experience with IDX system
Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, the only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.
Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.