Utilization Intake Review Coordinator

This is a fully remote position, open to applicants in Vermont.

📋 Description

• Oversee the initial collection and data entry of clinical information necessary for utilization review processes.

• Confirm patient information accuracy.

• Prepare and send authorization requests to nursing personnel or the external UR vendor AHH.

• Assist in the daily operations of the Utilization Review department and support the Lead Utilization Review Intake Coordinator.

• Input clinical and intake data into the designated platform and direct it to the appropriate vendor.

• Stay informed about utilization review procedures and timelines.

• Conduct outreach calls, gather data using provided scripts, tools, and protocols, while meeting productivity and performance standards.

• Handle calls in a courteous manner while maintaining a customer-service-oriented approach.

• Refer cases to the appropriate staff or clinical team members as per workflow requirements.

• Manage incoming and outgoing correspondence and faxes according to established standards and timelines.

• Process urgent scanning and retrieve documents intended for Utilization Review.

• Clearly and accurately communicate agreed-upon resolutions.

• Follow standard operating procedures while keeping current knowledge of member benefits, rights, and responsibilities.

• Undertake other related responsibilities and projects within assigned deadlines.

• Interpret plan language and apply it to intake responsibilities.

• Comply with company policies and procedures.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of 1-2 years of experience in the healthcare industry.

• Proficient computer skills, including MS Office (Word, Excel, and Outlook) and Internet applications.

• Strong reading comprehension skills.

• Self-motivated and self-directed; able to work independently without constant supervision.

• Excellent communication and problem-solving skills.

• Must be eligible to work in the United States; the employer participates in E-Verify.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• Biannual employer contributions to HSA, covering 50% of the annual deductible for the HDHP plan.

• Company-provided Basic Life and AD&D insurance.

• Employer-paid Short-Term and Long-Term Disability insurance.

• Flexible Spending Accounts.

• 401(k) Retirement Plan with up to a 6% employer match.

• Fully vested after 3 years of service.

• Over 10 paid holidays annually.

• Fully paid half-day Summer Fridays.

• Generous paid vacation and sick leave.

• Annual Paid Volunteer Day.

• Annual Tuition Reimbursement program.

• Annual Health and Wellness Reimbursement.

• Engaging company events.