Medical Management Care Coordinator, Utilization Management

Overview

Collects specific data in the medical management information system for the clinical staff. Resolves authorization issues as well as troubleshoots, researches and resolves related issues in a timely and efficient manner. Works under general supervision.

Compensation Range:$20.98 - $26.23 Hourly

Job Description

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays 

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability  

• Employer-matched retirement saving funds 

• Personal and financial wellness programs  

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care   

• Generous tuition reimbursement for qualifying degrees 

• Opportunities for professional growth and career advancement  

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities   

• Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals.

 

What You Will Do

• Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools.

• Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication.

• Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved.

• Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions.

• Provides triage and management of calls ensuring that established call performance targets are consistently achieved.

• Provides feedback to leadership regarding training needs

• Collaborates with management to determine the best approach to service customers, handle repeat vendor issues and other job-related matters to maximize and improve delivery, billing and payment of goods and services.

• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

• Participates in special projects and performs other duties as assigned.

Qualifications

Education:
High School Diploma or equivalent Required

Work Experience:

• Minimum of two years of experience in a customer service role Required

• Excellent oral and written communication skills Required

• Advanced personal computer skills, including Word, Excel or Access Required

• Utilization Management experience Preferred