530155-Referral Coordinator III

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Company: Oak Street Health 

Title: Utilization Management Care Coordinator (UMCC)

Location: Remote/ Treehouse 

Role Description:

The Utilization Management Care Coordinator (UMCC) plays a pivotal role in overseeing the day-to-day operations of the Utilization Management (UM) department. Operational expertise will drive process improvements, optimize workflows, and enhance the quality of care delivery within the Utilization Management Team. This role interacts with the UM physician reviewers, external payer partners, and vendors. The UMCC will report to, and work alongside the Manager of Operations, Utilization Management.

Core Responsibilities:

• Provide day to day operational support for all UM delegated health plans 

• Support the OSH UM Physician Reviewer team with daily questions on authorizations

• Be a liaison between OSH UM team, and their vended clinical and non clinical partners

• Be a liaison and SME between OSH’s UM team and all contracted health plans

• Identify opportunities to streamline and optimize utilization management workflows, improve efficiency and reduce administrative burden.

• Collaborate and effectively communicate with internal departments, external partners, and vendors by supporting the UM escalation inbox

• Efficiently navigate between multiple electronic platforms

• Provide education to internal and external individuals, being a Subject Matter Expert (SME) in Utilization Management

• Support ad hoc Utilization Management requests, by calling, entering, and approving services as needed

• Support ad hoc processes for improved workflow optimization and quality of care

• Meet standard performance and quality metrics

• Other duties, as required and assigned

What are we looking for?

• High School diploma or equivalent required

• Preferred 2 years of experience in utilization management, healthcare operations, or a similar role. 

• Excellent analytical, problem-solving, and decision-making skills.

• Strong communication and interpersonal skills, with the ability to collaborate effectively across multidisciplinary teams.

• Flexible and positive attitude

• Proficiency in utilization management software systems and Microsoft Office applications.

• Proven organizational and detail-orientation skills

• US work authorization

• Someone who embodies being Oaky

What does being Oaky look like?

• Radiating positive energy

• Assuming good intentions

• Creating an unmatched patient experience

• Driving clinical excellence

• Taking ownership and delivering results

• Being relentlessly determined

Why Oak Street Health?

Oak Street Health is on a mission to Rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient’s communities, and focused on the quality of care over volume of services. We’re an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody “Oaky” values and passion for our mission.