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

• Affords assistance in the prior authorization of services and ongoing authorization requests
• Affords assistance 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
• Serves 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

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

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