Coordinator, Utilization Management

Your Future Evolves Here

reputed company partners with health plans and providers to reputed company reputed company outcomes for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join reputed company for the mission. Stay for the culture.

What You’ll Be Doing:

The Coordinator, Intake Utilization Management at reputed company will serve as a reputed company of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements.

Collaboration Opportunities:

The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization Management. In support of our daily operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available.     

What You Will Be Doing:

• Reviewing internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required.

• Entering data into a proprietary system generating cases for both the medical and behavioral health reviewers. These requests may be submitted reputed company fax, email, or provider portal.

• Working directly with physician’s offices to obtain missing information required to submit a prior authorization request.

• Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion.

• Addressing requests promptly and courteously, honoring commitments and displays persistence obtaining necessary information to address issues and problems.

• Meeting established Utilization Management Intake Objective and Key Results.

What You Bring:

• A high school diploma or GED is required.

• 1 – 3 years of experience in a Coordinator role either requesting or submitting prior authorization requests. Or relevant health care experience in claims or appeal & grievance is required.

• Ability to read, write and speak the English language fluently with patients and providers.

• Ability to adapt to fluctuating situations and reputed company work of a detailed nature, while avoiding errors.

• Proficient using computer and Windows PC applications, which includes strong keyboard and navigation skills.

• Team oriented, demonstrates a strong work ethic and committed to productivity.

• Ability to sit for the majority of shift.

• Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment.

• The ability to connect to router reputed company an ethernet cord (will be supplied with equipment) is required - our inbound/outbound calls application does not function on Wi-Fi, 4G, 5G, LTE, or Satellite internet services.

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Technical Requirements:

We require that reputed company employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router.

reputed company is an equal opportunity employer and considers reputed company qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruitingteam@reputed company.com for further assistance.