Remote Intake & Utilization Coordinator

Evolent; City of Albany (NY); Remote; USD 25,000 - 36,000; Full time

Job summary

Evolent is seeking a Coordinator, Intake Utilization Management to serve as the point of contact for processing prior authorization requests in line with policies and client contracts. This remote role supports physicians and providers with data entry and collaboration with medical and behavioral health reviewers.

You will work with a clinical team including LVNs, LPNs, RNs, LMSWs, LCSW, LPCs, and other leaders; the schedule is 9:30 am–6 pm Pacific with rotating weekends and holidays.

Qualifications

• A high school diploma or GED – 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. Required
• Previous background/experience with Oncology.
• Ability to read, write, and speak the English language fluently with patients and providers. – Required
• Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors. – Required
• Proficient in using computer and Windows PC applications, which includes strong keyboard and navigation skills. – Required
• Team-oriented demonstrates a strong work ethic and is committed to productivity. – Required
• Demonstrated ability to meet established goals while balancing a workload and prioritizing assignments in a remote environment. – Required

Responsibilities

• 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 generates cases for both the medical and behavioral health reviewers. These requests may be submitted via 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 in obtaining necessary information to address issues and problems.
• Meeting established Utilization Management Intake Objectives and Key Results.

Skills

Prior authorization experience

Fluent English

Detail oriented

Remote work capable

Team player

Oncology knowledge

Education

High school diploma or GED

Tools

Windows PC

Job description

Evolent is seeking a Coordinator, Intake Utilization Management to serve as the point of contact for processing prior authorization requests in line with policies and client contracts. This remote role supports physicians and providers with data entry and collaboration with medical and behavioral health reviewers.

You will work with a clinical team including LVNs, LPNs, RNs, LMSWs, LCSW, LPCs, and other leaders; the schedule is 9:30 am–6 pm Pacific with rotating weekends and holidays.