Utilization Management Administration Coordinator – SNF

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

📋 Description

• Offers non-clinical assistance for policies to ensure members receive the most suitable treatment, care, or services while utilizing these services.

• Operates fully remotely.

• Oversees NLP's for chart evaluations for the nursing team.

• Develops and submits authorizations for review.

• Conducts inbound and outbound calls to engage with providers and members to confirm clinical details, discharge dates, and admission statuses.

• Records completed calls and attaches the clinical information obtained.

• Requests clinical documentation from providers and facilities.

• Composes written correspondence.

• Generates and distributes determination letters.

• Collaborates with various roles, departments, providers, and team members.

⛳️ Requirements

• A minimum of 1 year of experience in an administrative support role.

• Previous professional experience with Microsoft Word, Outlook, and Excel, along with the ability to type and input data.

• Capacity to adapt to new systems (proficient to advanced level).

• Experience in Utilization Review or Prior Authorization within a managed care environment (preferred).

• Proficient in using electronic medical record and documentation software (preferred).

• Familiarity with medical terminology or ICD-10 codes (preferred).

• Previous experience in member service or customer service via telephone (preferred).

• Experience with Skilled Nursing Facilities (SNF) or Home Health services (preferred).

• Prior experience with CGX, SRO, and HCHB (preferred).

• Previous experience in a metrics-driven environment (preferred).

• Experience in the healthcare sector (preferred).

🏝️ Benefits

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off, including company holidays, personal holidays, and paid parental and caregiver leave.

• Short-term and long-term disability insurance.

• Life insurance and numerous additional opportunities.