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Brighton Health Plan Solutions · 1 day ago

Utilization Management Coordinator

United States

Full-time

Remote

New Grad, Entry Level

Brighton Health Plan Solutions is a healthcare enablement company focused on improving how healthcare is accessed and delivered. The UM Coordinator is responsible for coordinating the prior authorization process, ensuring effective communication with members and providers, and maintaining accurate documentation and compliance with policies.

AdviceHealth CareHospital

Growth Opportunities

Hiring Manager

Paul Pascale

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, including inbound and outbound calls as needed

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

Medical record reviewCPT codesMedical terminologyJIVAThird party payor processesCustomer service skillsData entry skillsMicrosoft WordMicrosoft ExcelCommunication skillsAttention to detailProblem-solving skills