At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

UPMC Life Changing Medicine
Search Our Jobs

   Current UPMC employees must apply in HR Direct

Managed Care Specialist

Description

Purpose:
Answers all incoming phone calls in the test scheduling area and schedules all testing requested by physician within the group practice for test orders. Coordinates patient care in accordance with required pre-certification

Responsibilities:
  • Fax requests and letters to provider or facility performing test/procedure.
  • Understands roster management and is able to assist with it as assigned
  • Takes incoming calls and relays messages appropriately.
  • Insures timely flow of information regarding managed care contacts and/or patients to specialist, primary care physicians, staff and patients.
  • Gives patients complete information regarding any test or procedures being performed, including any preparation requirements.
  • Schedules diagnostic testing or procedures outside of for patients.
  • Pre-certifies patient services and obtains necessary approval of specialties, hospital admissions, emergency treatment, out of office testing, rehabilitation, DME, and any other necessary service.
  • Applies principles of specific managed care product to each task to insure contractual compliance.
  • Updates patient chart with scheduled appointment date and time, prep, prints instructions if any.
  • Informs HIS Department if any information needs to be sent to consulting physician office.
  • Works with manager to maintain files, coordinates patient care as it relates to quality assurance and utilization review.
  • Responds to documents and orders from physicians regarding the ordering of tests, procedures and appointment with specialist per physician orders.
  • Keeps current with managed care products and how changes may affect.

Qualifications

Requirements:
  • Graduate of an accredited Medical Secretarial school, accredited Medical Administrative assistant program, accredited Medical Assistant program or LPN program (valid state license) or one year vocational technical school; minimum six months related experience and/or training; or equivalent combination of education and experience. 
  • Medical terminology required.
Licensure, Certifications, and Clearances:
  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Total Rewards

    More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

    Our Values

    At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

       Current UPMC employees must apply in HR Direct

    Talent Network