Utilization Management Associate

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 12%

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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 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 related to discharge planning and utilization review • Monitor member eligibility • Conduct outreach calls to hospitals for follow-up clinical and discharge information • Process new admissions, including updating patient demographics, creating cases in BabyTrax®, documenting cases in the client system, and assigning Clinical Care Nurses • Communicate verbal and written prior authorizations according to client specifications • Receive incoming Utilization Management calls and refer them to appropriate staff • Maintain compliance with policies, procedures, regulations, patient safety, risk management, regulatory, and accreditation requirements • Maintain accurate and complete documentation • Provide additional support and project work across Care Management areas as needed • Report to the Supervisor of Utilization Review

🎯 Requirements

• 1–3 years of experience in customer service in a healthcare environment • HS diploma or equivalent required • College degree preferred • Insurance/payor experience preferred • Working knowledge of healthcare terminology • Professional verbal and written communication skills • Problem-solving skills with the ability to identify root causes and implement workable solutions • Intermediate to advanced proficiency in Outlook, Excel, PowerPoint, and Word • Must be fluent in English • Proficiency in a second language is highly desirable • Self-motivated and willing to learn multiple tasks • Well-organized and able to prioritize tasks • 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