Utilization Management Associate

About the role

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization, improves access, educates family members and reduces costs. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to home and throughout the first year of life.

Responsibilities

• intake, screening and precertification of appropriate healthcare services
• assisting the Clinical Care Nurses with clerical tasks associated with discharge planning/utilization review functions
• Monitor Member eligibility
• Perform outreach calls to hospitals for follow-up clinical information and discharge info
• Process new admissions: this includes update of patient demographics; create new case in BabyTrax®; document new case in client system; assign Clinical Care Nurse
• Communicate verbally and/or written prior authorizations based on client specifications
• Receive incoming calls for UM and refer to appropriate staff member
• Adheres to policies, procedures and regulations to ensure compliance and patient safety.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
• Provides additional support and project work within the various Care Management areas of accountability as needed

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, with the ability to clearly articulate thoughts and ideas as well as interact professionally and effectively with members, clients, and staff from all departments within and outside the company.
• Problem solving skills with the ability to look for root causes and implementable, workable solutions.
• 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.

Skills

• 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.

Benefits

• Paid Time Off
• Paid Parental Leave
• Medical, dental, vision benefits
• 401K with company match