UM Coordinator - #176479

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

JOB SUMMARY:

The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.

PRIMARY RESPONSIBILITIES:

• Assists in the prior authorization of services and ongoing authorization requests
• Assists in completing authorization updates as needed based on the care plan of the member
• Coordinates with providers regarding authorization activities
• Coordinates communication between authorization clinical staff, members and providers as needed
• Act as liaison and member advocate between the member/family, physician(s) and the care team to ensure timely and effective communication in regards to the member’s care
• Participates in case round meetings and on-going education activities
• Ensures that all job responsibilities are carried out in compliance with CPHL and State and Federal regulations
• Other assigned duties
  
  

EDUCATION AND EXPERIENCE:

Education

Required: HS Diploma

Preferred: Bachelor’s Degree

Type of Experience

Required:

• Strong written and verbal communication skills
• Computer proficiency
• Strong multi-tasking abilities
  
  

Preferred:

• Experience working within a managed care environment
  
  

Specific Technical Skills

Preferred:

• Computer proficiency in Microsoft Office applications
  
  

Certifications/Licensure:

Required: None

SCOPE INFORMATION

# Direct Reports: 0

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate a computer and telephone
  
  

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.

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