Lead, Care Coordinator

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🕒 Yesterday

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟠 Senior

✨ Care Coordinator

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NeueHealth

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💸 Finance

Healthcare • Healthcare Insurance • Finance

NeueHealth is a healthcare company focused on providing accessible, affordable, and high-quality care to all health consumers. Formerly known as Bright Health, it operates through two primary segments: NeueCare, which delivers comprehensive healthcare services via owned and affiliated clinics, and NeueSolutions, which supports independent providers in performance-based care arrangements. With a strong emphasis on understanding patient needs, NeueHealth aims to align the interests of health consumers, providers, and payors to enhance healthcare experiences and outcomes.

📋 Description

• Lead the daily operations and workflow of the UM Coordinator team to ensure timely processing of authorization requests. • Serve as the primary resource and subject matter expert for UM Coordinators, providing guidance, coaching, and support on complex cases and operational issues. • Assist leadership with onboarding, training, mentoring, and ongoing development of new and existing UM Coordinators. • Monitor team productivity, work queues, turnaround times, and workload distribution to ensure compliance with regulatory and organizational standards. • Receive, review, and process incoming requests for authorization of medical services. • Coordinate with providers, members, and internal clinical staff to obtain required documentation for utilization reviews. • Enter authorization requests, updates, and determinations into the utilization management system accurately and efficiently. • Track and monitor pending authorizations to ensure timely processing and communication of decisions. • Collaborate with UM nurses and physicians to facilitate medical necessity reviews and ensure adherence to clinical guidelines. • Communicate authorization determinations (approvals, modifications, or denials) to providers and members within required regulatory timeframes. • Perform quality reviews of authorization documentation and identify opportunities for process improvement. • Assist leadership with audits, regulatory readiness, accreditation activities, and quality improvement initiatives. • Escalate complex operational or system issues to management and recommend process improvements to enhance efficiency and service quality. • Act as a liaison between internal departments, providers, health plans, and external vendors to resolve issues and improve collaboration. • Assist with reporting, metrics tracking, and monitoring of key performance indicators (KPIs). • Promote compliance with NCQA, CMS, state and federal regulations, health plan requirements, and organizational policies. • Maintain strict adherence to HIPAA and confidentiality standards.

🎯 Requirements

• High School Diploma or equivalent required; Associate's degree in Healthcare Administration or a related field preferred. • Minimum of 3–5 years of experience in a health plan or managed care environment. • At least 2 years of Utilization Management, Prior Authorization, or Case Management support experience required. • Previous experience serving as a team lead, trainer, mentor, or in an informal leadership role strongly preferred. • Demonstrated ability to interpret health plan benefits and authorization guidelines. • Bilingual (English/Spanish) required. • Medical Assistant certification or other healthcare certification preferred.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work arrangements • Professional development opportunities