DESCRIPTION

The Population Health Services Organization (PHSO) Managed Care Utilization Management Referral Coordinator reviews all incoming referrals, checks benefits, accesses Health Plan portals and approves request per house guidelines or escalates to RN. Previous Health Plan experience and the ability to work in multiple software systems and multiple screens is critical for this role. May interact with both internal and external customers. Perform other duties as required.

MINIMUM QUALIFICATIONS

• Proven experience working in a healthcare setting.

• Excellent communication skills both verbally and in writing.

• Proficient knowledge in Microsoft Office (Excel, PowerPoint and Access).

• Strong knowledge of technology, proficient skills and ability to navigate multiple computer systems in a fast-paced environment.

• Demonstrated ability to coordinate and research the review of difficult, complex Utilization Management issues.

PREFERRED QUALIFICATONS

• Knowledge of third party payors.
• Prior Authorization experience under Managed Care.
• Knowledge regarding Eligibility and member’s EOC (Explanation of Coverage).
• Knowledge of ICD-10 and CPT codes.
• Electronic Medical Record/Epic experience.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.