Sunrise Systems, Inc. · 12 hours ago
Utilization Management Coordinator - Healthcare
United States
Contract
Remote
Entry Level
1+ years expSunrise Systems, Inc. is a Health Services Organization that delivers clinically integrated and coordinated eye care solutions. They are seeking a Utilization Management Coordinator to process prior authorization requests from providers and ensure compliance with regulatory guidelines for health plan members.
Information Technology & Services
Hiring Manager
Ashwini M
Responsibilities
Process prior authorization requests, following internal policies and procedures
Adhere to contractual obligations with internal and external stakeholders
Appropriately forward all prior authorization requests to clinicians for medical review
Assure communication of approved outpatient surgical procedures to medical providers and health plan members
Assist in directing appropriate requests to in-network providers
Participate in the compilation of monthly departmental statistics
Distribute correspondence in adherence with department standards
Maintain appropriate logs, records, and reports as established by Utilization Management Department
Participate in process improvement activities
Adhere to federal HIPAA guidelines and associated corporate policies and procedures
Other duties as assigned
Qualification
Required
MUST BE available to work Saturday or Sunday - If the worker needs to work a weekend day they will know in advance and get a weekday off
No overtime is allowed for this role - It is open to remote anywhere but must work East Coast hours
Must have healthcare experience and knowledge of Excel
Bachelor's degree or equivalent related experience
1-2 years of UM healthcare management, and/or training; or equivalent combination of education and experience
Experience in a Health Care Management and/or HMO environment
Experience in utilization review/utilization management
Ability to work in a deadline-driven environment
Basic understanding of LCD/NCD and overall functions of Utilization Management
Excellent organizational skills
Outstanding accuracy in data entry and exceptional attention to detail
Ability to work independently and collaboratively
Strong computer skills and knowledge of MS Office products, including MS Excel required. Ability to quickly navigate between platforms as necessary
Strong written and verbal communication skills
Preferred
Understanding of CMS/ACHA guidelines is desirable
Knowledge/experience in NCQA Utilization Management guidelines is highly desirable
Company
Sunrise Systems, Inc.
Sunrise Systems was founded in 1990 with a clear vision to deliver world-class staffing service solutions in all labor categories, including IT consulting and solutions; all with the commitment to provide service that exceeds expectations and become the most trusted name in the industry.
501-1000 employees
H1B Sponsorship
Sunrise Systems, Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2020 (2)
Funding
Current Stage
Late StageLeadership Team
Ruchi Hajra
Senior Account Manager/Client Servicing/Talent Acquisition Partner
Company data provided by crunchbase