Job ID: J123902
Company: Highmark Inc
Location: Charleston, WV, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 22, 2018
This job captures all inbound requests for utilization review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax or phone, and at times may require follow-up calls with physicians or pharmacists.
Referral Level: 1
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EEO is The Law
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