Job description
About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan, Indiana and Ohio. The McLaren system includes 14 hospitals in Michigan and Ohio, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S.
We are looking for a Intake Specialist to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 to help vulnerable populations needing health coverage in Indiana. Our parent organization, McLaren Health Care, is a nonprofit integrated health system who believes all Indiana families should have access to high quality health care regardless of income. Our mission is to provide high quality health care. MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.
MDwise is seeking the right individual to join our team in our Medical Management department as an Intake Specialist. As an employee of MDwise, you will be a part of a dynamic organization that considers all of our employees as leaders in driving the organization forward and delivering quality service to all our members. Learn more about MDwise, Inc. at https://www.mdwise.org/
Position Summary:
The successful candidate will be responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case managers. They will work with the PCP, the member and management team to promote the delivery of quality services at the most appropriate and cost-effective setting. They will monitor members’ utilization patterns for identification of high-risk and under and overuse of services. They will also clarify benefits for providers.
This position is fully remote.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
Required:
- High school diploma or equivalent.
- Completion of a medical-related training program such as Medical Assistant, EMT or Nursing Assistant.
- Two (2) years’ experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting
Preferred:
- One (1) year Managed Care Utilization review experience
- Experience and knowledge of the preauthorization process for medical services
- Medical Assistant Certification
- Physician office experience
- Experience and knowledge of Medicare, HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, claims processing, membership/eligibility)
- Schedule: Full-time
- Requisition ID: 23003165
- Daily Work Times: 8:30 am - 5:00 pm
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No
Per Centers for Medicare & Medicaid Services (CMS) regulations, all McLaren employees must be vaccinated for COVID-19 by January 4, 2022. The regulation permits exemptions for employees with qualified medical disabilities or religious beliefs.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
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