Utilization Management Associate

🕒 September 25

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 36%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 46 days.
• Jobs at this company usually fill in 26 days.
• Reposted once.
• No salary listed.

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ProgenyHealth, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

ProgenyHealth, LLC is a company focused on transforming healthcare for women, infants, and families through its integrated Maternity and NICU Care Management solutions. With over 20 years of experience, ProgenyHealth provides a comprehensive care management solution to address the maternity and NICU challenges faced by modern health plans. By identifying risks early, the company aims to prevent preterm births, NICU stays, and complications during pregnancy and after delivery. ProgenyHealth operates as a trusted partner for health plans, overseeing a full maternal and infant care continuum, creating lasting relationships, and optimizing maternal and infant healthcare economics. The company also helps solve non-clinical social drivers impacting maternal and infant health, ensuring equitable, standardized, and predictable family care.

📋 Description

• Assist the ProgenyHealth utilization management program by providing administrative support to the Utilization Review department • Perform intake, screening, and precertification of appropriate healthcare services • Assist Clinical Care Nurses with clerical tasks associated with discharge planning and utilization review functions • Monitor member eligibility • Perform outreach calls to hospitals for follow-up clinical information and discharge information • Process new admissions, including updating patient demographics, creating new cases in BabyTrax®, documenting cases in the client system, and assigning Clinical Care Nurses • Communicate verbal and written prior authorizations based on client specifications • Receive incoming calls for utilization management and refer them to appropriate staff members • Adhere to policies, procedures, and regulations to ensure compliance and patient safety • Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements • Provide additional support and project work within various Care Management areas as needed • Report to the Supervisor of Utilization Review • Work Monday through Friday, 9:00am to 5:30pm EST, with flexibility as needed

🎯 Requirements

• 1 – 3 years of experience in customer service in a healthcare environment • HS diploma or equivalent required • Insurance/payor experience preferred • Working knowledge of healthcare terminology • Professional verbal and written communication skills • Problem solving skills with the ability to look for root causes and implementable, workable solutions • Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word • Must be fluent in English • Proficiency in a second language is highly desirable • Must be self-motivated and willing to learn multiple tasks • Must be well-organized and able to prioritize tasks • Must have commitment to excellence in customer service

🏖️ Benefits

• Paid Time Off • Paid Parental Leave • Medical, dental, vision benefits • 401K with company match • Short- and Long-Term Disability • Group Life Insurance • Tuition reimbursement • Professional development opportunities

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