UM Services Associate I — Authorization & Care Coordination

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

Job summary

Capital District Physicians Health Plan Inc is seeking an administrative professional to support Utilization Management workflows. You will handle inbound/outbound calls, create authorizations via phone, Care Advance Provider Tool, and fax for inpatient/outpatient procedures, behavioral health, and durable medical equipment.

You will engage with members and providers, respond to inquiries, and collaborate with multiple departments to ensure timely, accurate UM processes in a health plan

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 customers (members and providers) by delivering excellent customer-centered service.
• Responds to customers in a professional, efficient manner to encourage acceptance of products, services, and policies.
• Perform triage for UM Services.
• Serves as the primary contact for providers regarding authorization requests.
• Contacts members and providers concerning regulatory requirements relating to DOH notifications and NCQA guidelines.

Skills

Call center experience

Analytical skills

Written communication

Verbal communication

Organizational skills

Independent work

Team collaboration

Education

High School Diploma or GED

Job description

Capital District Physicians Health Plan Inc is seeking an administrative professional to support Utilization Management workflows. You will handle inbound/outbound calls, create authorizations via phone, Care Advance Provider Tool, and fax for inpatient/outpatient procedures, behavioral health, and durable medical equipment.

You will engage with members and providers, respond to inquiries, and collaborate with multiple departments to ensure timely, accurate UM processes in a health plan