Care Coordination & Utilization Review Specialist

Baptist Health; Homestead (FL); On-site; USD 26,000 - 34,000; Full time

Job summary

Baptist Health is seeking a Care Management Coordinator to join our team in Florida. This role coordinates information between the Care Management Department and third-party payors, ensures timely utilization reviews, and serves as the liaison with insurance companies to secure appropriate reimbursement.

You will work with Access Management and Patient Financial Services to ensure accurate submissions and support operational initiatives with regular reports and data analyses.

Qualifications

• Associates degree required.
• Bachelor's degree preferred or a combination of relative work experience.
• Administrative experience.
• Advanced computer knowledge including PowerPoint, MS Office and Excel.
• Ability to operate office equipment and learn new software.
• Excellent verbal and written communication and interpersonal skills.
• Multitasking, planning, critical and independent thinking.
• Healthcare regulatory agency experience preferred.

Responsibilities

• Coordinate information between Care Management and Third Party Payors to enable timely submissions.
• Submit utilization reviews to ensure proper reimbursement and prevent denials.
• Liaise between insurance companies and the Care Manager in response to requests for clinical reviews/authorizations.
• Maintain effective relationships with insurance companies through ongoing communication.
• Collaborate with Access Management and Patient Financial Services to ensure accurate submissions for reimbursement.
• Assist with staffing schedules, payroll, inventory management, purchasing and invoicing.
• Provide regular informational reports and data analyses for utilization review management.

Skills

Administrative experience

Verbal & written communication

Interpersonal skills

Multitasking

Planning

Critical thinking

Independent thinking

Education

Associates

AA (Associate of Arts)

Bachelor's degree preferred

Tools

PowerPoint

MS Office

Excel

Job description

Baptist Health is seeking a Care Management Coordinator to join our team in Florida. This role coordinates information between the Care Management Department and third-party payors, ensures timely utilization reviews, and serves as the liaison with insurance companies to secure appropriate reimbursement.

You will work with Access Management and Patient Financial Services to ensure accurate submissions and support operational initiatives with regular reports and data analyses.