UM Services Rep I — Authorization & Care Support (Remote)

Capital District Physicians Health Plan Inc; City of Rochester (NY); Sur place; USD 28 000 - 37 000; Plein temps

Avantages offerts par ce poste

Remote work option

Résumé du poste

Capital District Physicians Health Plan Inc is seeking a Level I–III Utilization Management Administrative Support to handle inbound/outbound calls, process authorizations, and assist with regulatory requirements. The role requires attention to member privacy, strong communication, and teamwork in a fast-paced call center environment.

Responsibilities span triage, provider communications, and collaboration with Claims and Care Management to ensure timely, accurate authorizations for inpatient

Qualifications

• High school diploma or GED required.
• Proficiency with Microsoft Office.
• Call center experience preferred.
• Strong written and verbal communication.
• Excellent organizational skills.

Responsabilités

• Handle inbound/outbound calls from members and providers.
• Process authorizations via phone, Care Advance Tool, and fax.
• Respond to regulatory notifications and NCQA guidelines.
• Support UM Services with triage and research inquiries.
• Assist with project tasks and training for UM reps.
• Coordinate with Claims, Customer Service, and care management units.

Connaissances

Customer service

Communication

Analytical

Problem solving

Teamwork

Independent work

Multitasking

Call center

Formation

High School Diploma or GED

Outils

FACETS

PEGA

Care Advance Tool

Description du poste

Capital District Physicians Health Plan Inc is seeking a Level I–III Utilization Management Administrative Support to handle inbound/outbound calls, process authorizations, and assist with regulatory requirements. The role requires attention to member privacy, strong communication, and teamwork in a fast-paced call center environment.

Responsibilities span triage, provider communications, and collaboration with Claims and Care Management to ensure timely, accurate authorizations for inpatient