provides non-clinical support for policies ensuring the most appropriate treatment, care or services for members using services
work fully remote
manage NLP's for chart reviews for the nursing team
build and pend authorizations for review
perform inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status
document completed calls and attach clinical information received
request clinical information from providers/facilities
create written correspondence
create and distribute determination letters
collaborate with multiple roles/departments/providers/team members

1+ years' experience working in an administrative support capacity
Prior professional experience of Microsoft Word, Outlook and Excel with the ability to type and enter data
Ability to new systems (proficient to advanced)
Experience with Utilization Review or Prior Authorization within a managed care organization (preferred)
Proficient using electronic medical record and documentation programs (preferred)
Experience with medical terminology or ICD-10 codes (preferred)
Prior member service or customer service telephone experience (preferred)
Experience with SNF or Home Health (preferred)
Prior experience with CGX, SRO and HCHB (preferred)
Prior experience in a metric driven environment (preferred)
Prior experience in the healthcare industry (preferred)

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability
life insurance and many other opportunities

Utilization Management Administration Coordinator – SNF

Key skills