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Utilization Management Coordinator I

Company: Cenpatico
Location: Harrisburg
Posted on: November 20, 2020

Job Description:

Utilization Management Coordinator I USA-Pennsylvania-Harrisburg Position Purpose: The Utilization Management Coordinator l may perform duties in one or more of the following areas: Prior Authorization Unit, Hospital Notification Unit, Concurrent Review Unit, Medical Review Unit or Medicare Outreach Team. * All Units: * Accurately and effectively applies policies, benefit and eligibility policies, procedures and standards; requesting assistance of supervisor or appropriately licensed health professional when necessary. * Accurately documents all activities as per policy including entry into automated systems. * Meets or exceeds established performance goals including but not limited to service, quality, productivity and turn-around time. * Professionally interacts with customers, acting as a liaison between the beneficiary, provider, facility and Health Net. * Maintains confidentiality of all PHI in compliance with state and federal law and Health Net Policy. * Reports suspected fraud and abuse as per company policy. * Performs required clerical support duties. * Performs other duties as assigned Medicare Outreach Team (MOT): * Performs outbound outreach calls to members and providers in support of Medicare program and QI initiatives such as RAF, Star Ratings, etc. * Answers in-coming calls related to outreach activities. * Cross trains to support other Medical Management Units PCU, HNU, CCR and MRU. The Utilization Management Coordinator l supports and coordinates intake activities in Medical Management. Education/Experience: High School diploma or GED required. Six months data entry experience.. Experience in a health care, customer service or a managed care setting preferred. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Full-time

Keywords: Cenpatico, Harrisburg , Utilization Management Coordinator I, Executive , Harrisburg, Pennsylvania

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