UM Care Coordinator
JOB SUMMARY:
The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.
PRIMARY RESPONSIBILITIES:
Assists in the prior authorization of services and ongoing authorization requests
Assists in completing authorization updates as needed based on the care plan of the member
Coordinates with providers regarding authorization activities
Coordinates communication between authorization clinical staff, members and providers as needed
Act as liaison and member advocate between the member/family, physician(s) and the care team to ensure timely and effective communication in regards to the member’s care
Participates in case round meetings and on-going education activities
Ensures that all job responsibilities are carried out in compliance with CPHL and State and Federal regulations
Other assigned duties
EDUCATION AND EXPERIENCE:
Education
Required: HS Diploma
Preferred: Bachelor’s Degree
Type of Experience
Required:
Strong written and verbal communication skills
Computer proficiency
Strong multi-tasking abilities
Preferred:
Experience working within a managed care environment
Specific Technical Skills
Preferred: Computer proficiency in Microsoft Office applications
Certifications/Licensure:
Required: None
SCOPE INFORMATION
# Direct Reports: 0
PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to operate a computer and telephone
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.