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 the client'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.
TekWissen provides a unique portfolio of innovative capabilities that seamlessly combines clients insights, strategy, design, software engineering and systems integration. Our tightly integrated offerings are tailored to each client's requirements and span the services spectrum from Application Development/Maintenance, testing, IT Consulting & staffing for IT Infrastructure Management through strategic consulting and industry oriented Business Process. Our end-to-end Business Process as a Service (BPaaS) solutions support complex, high-value, knowledge-based work. Combining applications, platforms, infrastructure, knowledge processes, and domain expertise allows us to deliver greater efficiencies and innovative business capabilities.