Brighton Health Plan Solutions · 6 hours ago
Utilization Management Coordinator
United States
Full-time
Remote
Entry Level
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Hiring Manager
Paul Pascale
Insider Connection @Brighton Health Plan Solutions
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Responsibilities
Research and confirm authorization requirements and communicate to member, providers, and facility staff.
Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation and provider participation status.
Create cases within documentation system in accordance with departmental workflows, policies, and procedures.
Identify and correctly attach clinical documentation to appropriate cases within the documentation system.
Interact telephonically with members, providers, and facilities to determine requests for type of care.
Maintain accurate documentation within the clinical record according to workflows, policies and procedures.
Collaborate with the clinical team to address provider or member questions, issues, or concerns.
Play an active role in continuous improvement activities and quality initiatives to support positive outcomes for members, providers, and clients.
Maintain professional communication with all internal and external stakeholders.
Qualification
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Required
HS diploma or GED is required.
Strong skills in medical record review.
Excellent customer service and communication skills.
Ability to define problems, obtain data, and establish facts.
Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Word and Excel.
Excellent data entry skills.
Familiarity with medical terminology required.
Preferred
Bachelor’s degree preferred, but not required.
Familiarity with third party payor processes and procedures strongly desired.
Company
Brighton Health Plan Solutions
Brighton Health Plan Solutions is a health care company that specializes in health plan management service.
Founded in 2016
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Jim Cusumano
Co-Founder, President and CEO
Recent News
Company data provided by crunchbase
