UM Care Coordinator

Centers Plan for Healthy Living; New York (NY); On-site; USD 50,000 - 70,000; Full time

Job summary

Centers Plan for Healthy Living is seeking a Utilization Management Care Coordinator to assist members in their Managed Long Term Care program. The role involves managing prior authorization requests and ensuring effective communication between members, physicians, and the care team.

Ideal candidates will possess at least a high school diploma, strong communication skills, and computer proficiency. The organization values diversity and is committed to equal opportunity in hiring.

Qualifications

• Required: HS Diploma, Preferred: Bachelor's Degree.
• Required: Strong written and verbal communication skills.
• Required: Strong multi-tasking abilities.
• Preferred: Experience in managed care environment.

Responsibilities

• Assists in prior authorization of services.
• Coordinates with providers on authorization activities.
• Acts as liaison between members and the care team.
• Participates in case round meetings.

Skills

Strong written and verbal communication skills

Computer proficiency

Strong multi-tasking abilities

Education

HS Diploma

Bachelor's Degree

Tools

Microsoft Office

Job description

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

Job Summary

The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.

Primary Responsibilities

• Assists in the prior authorization of services and ongoing authorization requests
• Assists in completing authorization updates as needed based on the care plan of the member
• Coordinates with providers regarding authorization activitiesCoordinates communication between authorization clinical staff, members and providers as needed
• Acts as liaison and member advocate between the member/family, physicians and the care team to ensure timely and effective communication with regard to the member’s care
• Participates in case round meetings and ongoing education activities
• Ensures that all job responsibilities are carried out in compliance with CPHL and State and Federal regulations
• Other assigned duties

Education And Experience

Education

Required: HS Diploma

Preferred: Bachelor's Degree

Type of Experience

Required

• Strong written and verbal communication skills
• Computer proficiency
• Strong multi-tasking abilities

Preferred

• Experience working within a managed care environment

Specific Technical Skills

Preferred: Computer proficiency in Microsoft Office applications

Certifications/Licensure

Required: None

Physical Requirements

• Must be able to operate a computer and telephone

Center Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.