CareCentrix

Coordinator - Utilization Management

US-CT-Hartford
Job ID
2017-4952
Category
Clinical/Utililization Management

Overview

The UM Coordinator is responsible for tracking and monitoring turnaround times to assure service requirements are met, coordinating with operations and clinical team members to intervene when service levels are at risk, and providing appropriate issue resolution and/or escalation when necessary. Responsible for monitoring production queues. Entering data into, maintaining, running reports and analyzing data from Clinical database. Coordinates with the clinical team to prepare for internal and customer audits.

Responsibilities

• Tracks cases that are recommended for denial thru all clinical bins
• Maintains the data to high quality standards. Analyzes data from the database. Runs reports from the database.
• Monitors the Clinical Review queue in the CareCentrix workflow management system to assure cases are being processed in accordance with required turnaround times.
• Assures that letters are generated and mailed within required timeframes.
• Works with operations departments, clinical, quality and correspondence departments to assure accuracy and timeliness processing from end to end.
• Works with Clinical Team to prepare forms and other necessary documentation for delivery to MD offices and external providers.
• Provides issue resolution and escalation to management when appropriate.
• Leverages review decision tools where appropriate to automate utilization management review
• Participates in special projects and performs other duties as assigned.

Qualifications

• High School Diploma or the equivalent required.
• Associates or Bachelor’s degree preferred.
• Two years insurance, quality improvement, or healthcare operations required.
• Must be comfortable with medical terminology.
• Must be proficient and comfortable in a computer-based environment.
• Knowledge of CareCentrix systems and processes preferred.
• Knowledge of Utilization Management, NCQA and URAC standards preferred.
• Embraces the values of accountability, consistency, engagement, empowerment, respect and outstanding service.
• This position requires excellent organization, communication, and problem solving skills, as well as the ability to effectively interact with all levels of management and highly diverse customers.
• Must be extremely detail-oriented and understand the critical importance of accuracy and timeliness. Demonstrates critical thinking and has the ability to analyze data to understand an expected outcome.
• Must be able to effectively manage and prioritize tasks and thrive in a fast-paced environment.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill and/or ability required.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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