Healthcare Utilization Coordinator I

Capital District Physicians’ Health Plan, Inc.; City of Rochester (NY); On-site; USD 28,000 - 37,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Retirement plan

Wellness program

Paid time off

Job summary

Capital District Physicians’ Health Plan, Inc. is seeking an UM Services support specialist to assist with inbound/outbound calls, authorizations, and regulatory compliance within a call-center style environment.

This role supports utilization management workflows and ensures timely, accurate processing for inpatient and outpatient procedures, behavioral health, and durable medical equipment. You will collaborate with Claims, Customer Service, and care management units to ensure end-to-end

Qualifications

• High School Diploma or GED.
• Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.
• Call center experience preferred, not required.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work within a team.
• Demonstrated organizational skills to manage multiple projects and priorities.
• Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.

Responsibilities

• Facilitates inbound and outbound calls to members and providers with information about services.
• Serves as primary contact for authorization requests.
• Coordinates end-to-end authorization processes with multiple departments.
• Assists with coordinating regulatory notifications and documentation responsibilities.
• Provides timely responses to inquiries and maintains accuracy and privacy standards.

Skills

Strong analytical skills

Strong written and verbal comms.

Demonstrated organizational skills

Self-motivated and independent work

Education

High School Diploma or GED

Job description

Capital District Physicians’ Health Plan, Inc. is seeking an UM Services support specialist to assist with inbound/outbound calls, authorizations, and regulatory compliance within a call-center style environment.

This role supports utilization management workflows and ensures timely, accurate processing for inpatient and outpatient procedures, behavioral health, and durable medical equipment. You will collaborate with Claims, Customer Service, and care management units to ensure end-to-end