McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, 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 53 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 our Indiana-based health plan, working 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. Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Summary:

Responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case managers. Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Monitors members’ utilization patterns for identification of high-risk and under and over use of services. Clarifies benefits for providers.

This position is fully remote.

• High school diploma or equivalent.
• Two (2) years’ experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting and completion of a medical-related training program such as Medical Assistant, EMT or Nursing Assistant.

• Three (3) years’ experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting.

• One (1) year Managed Care Utilization review experience
• Experience and knowledge of the preauthorization process for medical services
• 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).

Additional Information

• Schedule: Full-time
• Requisition ID: 24004307
• Daily Work Times: 8:00 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No

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.