Sunrise Systems, Inc. · 20 hours ago
Utilization Management Coordinator
United States
Full-time
Remote
Entry Level
$19/hr - $22/hr
1+ years expSunrise Systems, Inc. is a leading Health Services Organization specializing in clinically integrated eye care solutions. They are seeking a Utilization Management Coordinator responsible for processing prior authorization requests to ensure quality clinical outcomes for health plan members, while adhering to regulatory guidelines and internal policies.
Information Technology & Services
Responsibilities
Work prior authorizations, troubleshooting issues, speaking to providers, and scheduling peer-to-peers
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
Maintains 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
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
Benefits
ACA compliant medical coverage
Dental insurance
Vision insurance
Sick time benefits as required per State regulations
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