Utilization Management Coordinator

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🕒 Julho 18

☕ Washington – Remoto

☕ Washington – Remote

💵 $21 - $28 / hora

⏰ Tempo Integral

🟢 Júnior

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Community Health Plan of Washington

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1992

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

O Community Health Plan of Washington é um plano de saúde sem fins lucrativos, fundado em 1992 pelos centros de saúde comunitários de Washington, que oferece planos de seguro Medicaid (Apple Health), Medicare Advantage, Dual-eligible e Individual & Family em todo o estado de Washington. Oferece gerenciamento de cuidados, saúde comportamental, atendimento virtual, apoio aos membros e serviços comunitários, além de programas como recompensas, assistência linguística e redes de provedores para atender às necessidades de saúde dos membros e da comunidade.

Descrição

• Performs data entry for all referral, prior authorizations and hospital notifications; attaches and/or includes clinical documents as needed • Utilizes knowledge to determine appropriate CPT, HCPC, ICD-10 codes using CMS, NCQA and HCA criteria • Researches and validates benefit and prior authorization requirements to determine appropriate course of action within the Care Management system • Reviews, corrects, and approves authorization requests via the web portal; determines appropriate level of complexity and refers cases requiring clinical review to a nurse reviewer • Reviews completed denial letters for accuracy and adherence to compliance deadlines • Edits and proofreads content for appropriate medical terminology and MCG criteria • Ensures letters are mailed within established timeframes • Accurately applies policies & procedures, benefit and eligibility standards to all incoming requests • Conducts research, validates data, and responds to complex inquiries from multiple sources, including but not limited to members, nurses, medical providers, customer service, operations, appeals, case management and care coordination

🎯 Requisitos

• Have an associate degree, or an equivalent combination of education and highly relevant experience • Have at least one (1) year of customer service experience, preferred • Have working experience in a Healthcare setting, preferred • Have working experience in a Managed Care setting, preferred • Are knowledgeable of medical terminology and healthcare processes, preferred • Are knowledgeable of Washington Apple Health and Medicare Advantage Plans, preferred

🏖️ Benefícios

• Medical, Prescription, Dental, and Vision • Telehealth app • Flexible Spending Accounts, Health Savings Accounts • Basic Life AD&D, Short and Long-Term Disability • Voluntary Life, Critical Care, and Long-Term Care Insurance • 401(k) Retirement and generous employer match • Employee Assistance Program and Mental Fitness app • Financial Coaching, Identity Theft Protection • Time off including PTO accrual starting at 17 days per year • 40 hours Community Service volunteer time • 10 standard holidays, 2 floating holidays • Compassion time off, jury duty