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Solis Health Plans · 15 hours ago

Utilization Management Care Coordinator

Doral, FL, US

Full-time

Onsite

New Grad, Entry Level

$20/hr - $23/hr

Solis Health Plans is a new kind of Medicare Advantage Company dedicated to providing transparent and effective solutions for members and providers. The Utilization Management Care Coordinator plays a crucial role in ensuring patients receive optimal healthcare experiences through scheduling, communication, and coordination of care.

Health CareHealth DiagnosticsPersonal Health

Responsibilities

Scheduling UM Authorization and Determination tasks

Refers all services requiring prior authorization to UM Nurse or BH UM Nurse as appropriate Manage determination placement

Communicate with nurses and physicians

Receives and responds to telephonic inquiries from providers regarding status of authorization requests and other questions or concerns

Guides practitioners to appropriate referral resources

Handle inbound calls and answer member and provider questions

Connect with new members via phone and email as requested

Communicate with members to determine and confirm their needs

Arrange and coordinate special equipment or therapy for at-home care

Maintain files and company information as required

Provide timely data entry referrals for continuing care as necessary

Perform benefit approvals on services, procedures, and tests that are listed on the UM Coordinator’s approval list. (These services do not require clinical judgment nor are reviewed for medical necessity. This list is reviewed as needed and at least annually for continued use by the UM Coordinator)

Process routine referral services that do not require a Prior Authorization

Ensures timely printing and mailing of pre-certification, authorization and denial letters

Appropriately documents interactions and activities into the UM electronic system

Produces reports from UM electronic system for review and analysis by appropriate Leadership team member

Assist the company care team with goal setting

Ensures compliance with all federal, state, and local regulations

Help with member data collection including medical records, HRA, etc

Maintain patient confidentiality

Related duties as needed

Qualification

Insurance experience in MedicareCMS guidelinesBilingual in EnglishSpanishComputer knowledgeWorking knowledge of medical terminologyHandle multiple functionsMeet deadlinesWork under stressDecision-making skillsOrganizational skillsInterpersonal skillsVerbal communication skillsWritten communication skillsWork independentlyWork in fast-paced environment

Required

BILINGUAL IN ENGLISH AND SPANISH IS REQUIRED

Post High School graduate courses or equivalent with significant experience in healthcare related customer service position; or equivalent combination of education and experience

Excellent computer knowledge is required, including proficient knowledge of Microsoft Office

Strong decision-making and organizational skills

Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization

Must be able to work with little or no supervision

Willingness and ability to function independently and as a team member

Working Knowledge of medical terminology

Ability to handle multiple functions and prioritize appropriately

Ability to meet strict deadlines

Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies

Ability to read, analyze, and interpret technical procedures or governmental regulations

Ability to define problems, collect data, establish facts, and draw valid conclusions

Strong decision-making, analytical skills