Clinical Associate, Medical Management

healthoptions; Maine; Hybrid; USD 42,000 - 59,000; Full time

Benefits offered by this job

Competitive cash compensation

Comprehensive health plans

Generous PTO

Future focused 401k match

Job summary

Community Health Options is seeking a Clinical Associate, Utilization Management to support Medical Management and coordinate functions across UM, CM, DM, TOC, POS and HP. The role balances advocacy for individuals with stewardship for the entire membership and requires adaptability to changing daily priorities.

The position involves periodic in-office work with remote options based on operational needs and supervisor approval, while maintaining high quality and productivity standards.

Qualifications

• Associate degree in health-related field preferred.
• Medical terminology background required.
• Proficient in English with verbal, written, interpersonal and public communications.
• Working knowledge of ICD-10/CPT/HCPCS codes preferred.
• Proficient with Microsoft Office products and accurate clinical documentation.
• Ability to maintain production levels with minimal supervision.

Responsibilities

• Provides administrative support of daily operations to include UM, CM, DM, TOC, POS and HP.
• Monitors utilization management incoming fax queue and creates new authorization shells.
• Updates authorization with applicable supporting/clinical documentation upon receipt.
• Successfully complete eligibility assessments in newly established authorizations.
• Monitor incoming phone calls and triages calls to the appropriate team member based on established workflows.
• Monitors outbound UM phone queue and contacts providers when additional information is needed to process an authorization request; documents updated information.
• Maintains confidentiality in all aspects of Member, Health Options people and company information.

Skills

Medical terminology

English proficiency

Microsoft Office

Education

Associate Degree in health related field

Tools

Microsoft Office

Job description

Base Compensation Range

$42,400 - $59,200 USD

Compensation & Benefits

• Competitive cash compensation
• Comprehensive health plans
• Generous PTO
• Future focused 401k match

POSITION SUMMARY

The Clinical Associate, Utilization Management reporting to the Assistant Manager of Utilization Management is responsible for supporting Medical Management operational needs in support of Community Health Options Medical Management approach which balances advocacy for the individual based on benefit design with stewardship for the entire membership through effective utilization management strategies. The incumbent provides administrative support to ensure effective and efficient program coordination across the health continuum regarding Utilization Management (UM), Case Management (CM), Disease Management (DM), Transitions of Care (TOC), Point-of-Service (POS), and Health Promotion (HP) services. This individual is nimble and consistently demonstrates ability to swiftly adapt and flex work assignments based on daily operational priorities while consistently functioning within role parameters. Periodic in-office work is required. Remote work is available based on operational needs, consistent adherence to quality and productivity standards, and supervisor approval.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Provides administrative support of daily operations to include UM, CM, DM, TOC, POS and HP.
• Monitors utilization management incoming fax queue and creates new authorization shells in accordance with established standards.
• Updates authorization with applicable supporting/clinical documentation upon receipt.
• Successfully complete eligibility assessments in newly established authorizations.
• Monitor incoming phone calls and triages calls to the appropriate team member based on established workflows.
• Monitors outbound UM phone queue and contacts providers when additional information is needed to process an authorization request; documents updated information in the applicable authorization template.
• Consistently references approved resources and follows established department procedures and workflows.
• Maintains confidentiality in all aspects of Member, Health Options people and company information.
• Any other project work or supportive duties (as assigned).

JOB SPECIFIC KEY COMPETENCIES (KSAs)

• Community Health Options People are expected to lead with integrity, humility, curiosity, and discipline. They must be self-motivated, highly effective and compassionate communicators, effectively managing work processes, and actively engaging in continuous process improvement.

DIVERSITY, EQUITY, AND INCLUSION STATEMENT

Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well. Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces:

• Respectful, open communication and cooperation between all employees.
• Teamwork and participation, encouraging the representation of all groups and employee perspectives.
• Balanced approach to work culture through flexible schedules to accommodate varying needs of our people.
• Employer and employee contributions to the communities we serve to promote a greater understanding and respect for each other.

QUALIFICATIONS AND CORE REQUIREMENTS

• Associate Degree in health related field, preferred.
• Medical office or Health Plan experience preferred.
• Medical terminology background, required.
• Working knowledge of ICD-10/CPT/HCPCS codes, preferred.
• Appreciation of cultural diversity and sensitivity towards individual preferences and needs of Member population.
• Proficient in English with verbal, written, interpersonal and public communications.
• Proficient with Microsoft Office products, typing, and ability to maintain accurate clinical documentation.
• Ability to maintain production levels and quality standards with minimal direct supervision.