Utilization Management Care Coordinator Location:

Doral, FL Schedule:

Monday -

Friday Type of Contract:

Temp Salary:

$20-$22 per hour

DESCRIPTION

ttg Talent Solutions is seeking a Utilization Management Care Coordinator to support healthcare coordination and utilization management activities. This position plays an important role in helping members receive timely, well-coordinated care by supporting authorization processes, communicating with members and healthcare providers, maintaining accurate documentation, and assisting with ongoing care needs. The ideal candidate is organized, compassionate, comfortable working in a fast-paced healthcare environment, and able to communicate effectively with both members and healthcare professionals. This is an onsite, Monday-Friday position.

Key Responsibilities:

Schedule utilization management authorization and determination tasks. Refer services requiring prior authorization to the appropriate Utilization Management Nurse or Behavioral Health Utilization Management Nurse. Support the management and placement of determinations. Communicate effectively with nurses, physicians, members, and healthcare providers. Receive and respond to provider inquiries regarding authorization requests and other questions or concerns. Guide practitioners to appropriate referral resources. Handle inbound calls and respond to member and provider questions. Connect with new members by phone and email as requested. Communicate with members to identify and confirm their needs. Coordinate special equipment or therapy needed for at-home care. Maintain required files, records, and organizational information. Provide timely data entry for continuing-care referrals. Perform benefit approvals for designated services, procedures, and tests that do not require clinical judgment or medical-necessity review. Process routine referral services that do not require prior authorization. Support the timely preparation and mailing of pre-certification, authorization, and denial correspondence. Accurately document interactions and activities within the utilization management electronic system. Produce reports from the utilization management system for leadership review and analysis. Assist the care team with goal setting. Support compliance with applicable federal, state, and local regulations. Assist with member data collection, including medical records and health risk assessment information. Maintain patient confidentiality at all times. Perform other related duties as needed.

REQUIREMENTS

Post-high-school coursework or equivalent education combined with significant experience in a healthcare-related customer service position, or an equivalent combination of education and experience. Medicare and managed-care insurance experience is preferred. Knowledge of CMS guidelines and InterQual is preferred. Working knowledge of medical terminology. Strong computer skills, including proficiency with Microsoft Office. Excellent organizational, analytical, prioritization, and decision-making skills. Strong listening, interpersonal, verbal, and written communication skills. Ability to communicate effectively with individuals at different organizational levels. Ability to work independently with little or no supervision while also contributing effectively as part of a team. Ability to manage multiple responsibilities and prioritize competing demands. Ability to meet strict deadlines and perform effectively in a fast-paced environment. Patient and empathetic approach when assisting an elderly population, including individuals with hearing or vision deficiencies. Ability to read, analyze, and interpret technical procedures and governmental regulations. Ability to define problems, collect information, establish facts, and draw appropriate conclusions. Self-motivated, organized, and capable of working effectively under stressful conditions. Bilingual English/Spanish required. At ttg, "We believe in making a difference One Person at a Time," ttg OPT. IND3