Utilization Management Administration Coordinator -- Home Health

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Full-Time, Remote Telephonic opportunity

The UM Administration Coordinator 2 supports the administration of utilization management by performing a variety of moderately complex administrative, operational, and customer service tasks.

Responsibilities may include significant telephonic interaction with providers, members, and other stakeholders, including receiving inbound calls, providing customer service, and supporting the intake of utilization management and prior authorization requests. Some associates may be assigned primarily or fully to telephonic responsibilities based on business needs.

Additional responsibilities may include creating and processing authorization cases, generating correspondence, triaging faxes and shared mailboxes, processing documentation, conducting calculations and data processing, and performing other administrative functions supporting utilization management. Specific work assignments may vary and may change over time based on business needs, volume, and operational priorities.

Assignments are generally semi-routine in nature.

The UM Administration Coordinator 2 provides non-clinical support for policies and procedures ensuring the best and most appropriate treatment, care, or services for members.

Associates must be comfortable working in a phone-based customer service environment, and some assignments may require the majority or entirety of the workday to be dedicated to inbound calls. Other assignments may include building and updating authorization cases, creating letters and other correspondence, processing and routing faxes, triaging shared mailboxes, reviewing and routing documentation, and completing other non-clinical administrative activities supporting the utilization management process. Associates are expected to demonstrate flexibility as work assignments may change based on business needs and operational priorities.

Decisions are typically focused on interpretation of area/department policy and process for completing assignments. Works within defined parameters to identify work expectations and quality standards but has some latitude over prioritization/timing and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Success in this role requires the following:

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Strong customer service and verbal communication skills, including the ability to professionally manage a high volume of inbound telephone interactions.
• Comfort providing telephonic support while simultaneously navigating multiple systems, documenting interactions, and accurately processing information.
• Excellent organizational and time-management skills.
• Technical savvy and ability to navigate multiple systems and screens while working cases.
• Collaboration skills to effectively interact with multiple parties, both internal and external.
• Flexibility and adaptability to work across telephonic and non-telephonic utilization management functions and transition between assignments based on business needs.
• An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Ability to make decisions regarding your own work methods, occasionally in ambiguous situations and with minimal direction, receiving guidance where needed.
• Ability to follow established guidelines, processes, and procedures.

Use your skills to make an impact