Medical Assistant, Utilization Management

WelbeHealth PACE helps seniors stay in their homes and communities by providing medical care and community-based services. We believe in going the extra mile and aim to make a genuine difference in our participants’ lives.

The Utilization Management Medical Assistant (UM MA) is accountable for the review and audit of authorization requests to ensure services are authorized and meet standard medical guidelines. Ensuring that the right care is done in the right place at the right time is a critical aspect of this role. The UM MA is also accountable for supporting the organization’s UM program through close auditing of participants’ charts and authorization requests. This role requires strong working knowledge of UM regulatory and documentation standards.

Essential Job Duties:

• Conduct review of consult summaries, imaging results, procedure summaries, and more, to determine if additional follow up services are requested
• Enter orders on behalf of PCP or ordering provider, based on PCP direction and consult summaries from external providers
• Manage departmental clinical inboxes, email inboxes, and fax queues to ensure appropriate handling of documents and authorization requests

Work closely with UM Coordinators, UM Nurses, Medical Records, Provider Networking, and center-based clinical staff to promote efficient and effective communication and document routing between multiple sources and systems

• Identify, document, and correct inconsistencies and gaps in participants’ orders with authorizations in the UM system
• Collaborate with providers, clinical staff, and others to resolve any authorization and order gaps identified
• Consistently meet operational performance requirements as detailed by data and company reporting

Job Requirements:

Current MA Certificate; MA experience in a home health/clinical setting preferred

2-year degree program in Medical Assistance Accredited by the Commission on Accreditation of Allied Health Education Program (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES)

• Certification by a Medical Assistant Certifying Organization approved by the State Medical Board, preferred
• Minimum of one (1) year of chart auditing or UM review experience, and a minimum of two (2) years of relevant administrative and clinical work
• Experience working in Athena Electronic Health Record, preferred
• Knowledge in Medicare and Medicaid UM regulations

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a

family member), pregnancy or other status protected by applicable law.

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