Clinical Assistant

• Screen incoming calls and/or faxes or other digital format for UM and/or CM and direct calls/faxes/other digital requests to the appropriate area.
• Identify and refer cases appropriately to the Case Management and/or Transition of Care department.
• Receiving, investigating and resolving customer inquiries and claims.
• Maintain departmental goals.
• Perform projects, review and handle reports as assigned.
• Load complete organization determination/notification for services designed by internal policy.
• Clearly document and key data in to the appropriate system using departmental guidelines.
• Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, requesting additional or clarifying information and giving direction as necessary.
• Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.

Clinical Assistant supporting BlueCare Plus Clinical Review Managers at BCBST

Clinical Assistant supporting BlueCare Plus Clinical Review Managers at BCBST. Key point of contact for providers and healthcare partners in a remote role.

• Conduct outbound calls to members/providers identified for care coordination support
• Assist with scheduling bone density scans and other preventive appointments
• Document member-reported concerns and escalate clinical questions to licensed staff
• Provide standardized call guide-based education approved by clinical leadership

PRN Clinical Assistant supporting preventive care and medication optimization

PRN Clinical Assistant supporting preventive care and medication optimization through member and provider outreach and administrative support in a fully remote role.

Clinical Assistant jobs in Tennessee

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Clinical Assistant

Clinical Assistant