• Serves as a support to health plan teams by completing administrative tasks and coordinating activities. • Manages all mailings to members and is responsible for necessary correspondence. • Documents all member/provider interaction in member database software per expected workflow. • Must project a positive and professional image. • Must be able to interact compassionately with members on a one-on-one basis and anticipate their needs through careful listening and patience. • Must be highly organized and able to handle multiple tasks under constant pressure. • Utilization management performs resource benefit policy management, triages inbound and outbound calls, processes intake requests, completes data entry and assigns cases to appropriate clinical team members. • Supports medical management programs and operations.

• The Clearance Specialist is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs. • Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services • Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc • Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing • Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including Reviewing and obtaining clinical documents for submission purposes • Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed • Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations • Generate new patient start of care paperwork