Monroe Regional Hospital is seeking an experienced Utilization Management Intake Coordinator. As a Utilization Management Intake Coordinator, you will be responsible for data entry for all prior authorization, concurrent review, and case management referrals for all Healthy Mississippi membership, via telephone, fax, and portal. This position will complete administrative processing/assessment of all utilization submissions and notifications based on member eligibility, insurance coverage requirements and other elements as determined by the plan. The Utilization Management Intake Coordinator is primarily administrative, designed to streamline the submission process for patients and providers to secure any pre-authorizations.

Other responsibilities include:

• Coordinating and optimizing administrative tasks, ensure a thorough review and processing of all utilization submissions and notifications.
• Provide timely and accurate responses to utilization queries and notifications.
• Refer authorizations to appropriate utilization review RN for processing
• Administrative support for Utilization Review RN services, includes requestion clinical documentation, sending faxes, letters and monitoring utilization queue.
• Assist in managing response letter content, generating letters, and coordinating delivery to patients and providers.
• Notifications to providers and members, including administrative approvals and denials
• Escalate expedited requests for authorization to Utilization Review RN staff
• Update patient health plan information used for administrative and clinical assessment, claims payment, and apply appropriate appeal rights
• Prepare data and records for internal and external audits
• Download from Cedar Gate software, daily prior authorization letters to mail service for daily mailing
• Collect, assemble and disseminate data related to Utilization Management Program performance and characteristics
• Complete monthly/quarterly/annual reports
• Act as liaison between members, providers and staff.
• Verify coverage and communicate with medical facilities to resolve any discrepancies.
• Follow-up on missing or inaccurate information and coordination with clinical staff and physicians; request additional information.
• Other duties as assigned.

Preferred Experience:

HEDIS, Utilization Management, Valued Based Care. Also prefer previous medical insurance experience and p.a. experience. Excellent organizational skills and time management skills necessary. Strong interpersonal skills are essential as this position will be communicating with patients, providers and staff. Experience with CPSI highly desired. Hybrid Remote work environment - 90% remote with approximately 10% of work required to be done onsite at the hospital.

Education:

HS Diploma or GED required; Experience with health insurance and authorizations preferred. Hours are primarily 8-5, M-F but some rotational weekend coverage may be required. Some Holiday coverage required.

Job Type:

Full-time Benefits:

401(k) Dental insurance Disability insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Vision insurance Application Question(s): Do you have previous experience in utilization management/review? Do you have previous experience working with prior authorizations?

Work Location:

Hybrid remote in Aberdeen, MS 39730