Utilization Management Coordinator I — Remote Options

Excellus BCBS; City of Albany (NY); On-site; USD 28,000 - 37,000; Full time

Job summary

Excellus BCBS in New York is seeking a UM Services Support role focused on administrative support and customer service. You will handle inbound/outbound calls, process authorizations, and liaise with providers and members regarding regulatory requirements.

Level I-III responsibilities include assisting with project tasks, coaching, and coordinating with multiple departments to ensure accurate and timely authorizations and care management referrals.

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.
• 2 years’ experience working with managed care or healthcare industry (Level II).
• 4 years’ experience working with managed care or healthcare industry (Level III).

Responsibilities

• Facilitates inbound and outbound calls to customers (members and providers) delivering excellent customer-centered service.
• Responds to customers in a professional, efficient manner to encourage acceptance of services and policies.
• Performs triage for UM Services and acts as primary contact for provider authorization requests.
• Notifies members/providers about regulatory requirements (DOH, NCQA) and documents responses.
• Coordinates authorizations via phone, Care Advance Provider Tool, and fax.
• Supports end-to-end processes with Claims, Customer Service, and care management units.
• Resolves escalated questions and supports scheduling and coordination tasks.

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Excellus BCBS in New York is seeking a UM Services Support role focused on administrative support and customer service. You will handle inbound/outbound calls, process authorizations, and liaise with providers and members regarding regulatory requirements.

Level I-III responsibilities include assisting with project tasks, coaching, and coordinating with multiple departments to ensure accurate and timely authorizations and care management referrals.