UM Coordinator

Summary:

Under the direction of the UM manager, communicates with clients, facilities, agents, providers, and members to collect pertinent service request data and disseminate information to the UM department’s clinical staff. Supports the authorization process by receiving incoming fax or phone service requests and initiating entry of service requests. Facilitates the UM authorization and appeals process. Serves as a resource to accept, transfer, or redirect information regarding MedReview policies, procedures and when applicable, benefit information. Triages information to ensure appropriate action is initiated to meet regulatory bodies’ standards and to maintain the quality and timeliness of the authorization process. Checks service requests for completeness of information.

Education: Associate degree preferred.

Qualifications:

• Excellent interpersonal/communication skills.
• Ability to correctly complete data entries using corporate applications on a high-volume basis.
• Adaptable, demonstrates flexibility to changes within the department.
• Able to respond knowledgeably and professionally to peers and callers.
• Excellent organizational skills and ability to prioritize multiple, consecutive tasks.
  
  

Experience:

• Two +years of office experience desirable, preferably in a call center or medical services environment.
• Computer skills (Excel, Word, Outlook, Adobe) and data entry
• Excellent telephone skills
  
  

Job Responsibilities:

This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of the department and MedReview in general.

• Accepts authorization service requests and notifications for NYCHSRO/MedReview members, screens for member eligibility.
• Initiates entry of request(s) into utilization management system as applicable
• Assists with departmental e-fax process.
• Generates notifications to members, facilities, and agencies according to established protocols.
• Timely entry of notes in the utilization management application for each event per protocol
• Interfaces with other MedReview departments and external customers to obtain and verify information relevant to pre-authorization requests including authorization details when requested for appeals.
• Communicates with facilities/agencies/providers/members to collect pertinent data regarding an episode of care and give applicable authorization numbers and status to facility/agency/member. Updates authorization information in utilization management system (Case Trakker)
• Manages calls from providers and members with excellent customer service.
• Assist NYCHSRO/MedReview providers, members and/or authorized representatives with questions and concerns regarding authorizations.
• Strictly observes the NYCHSRO/MedReview policy regarding confidentiality of member and provider information.
• Responsible for maintaining departmental files, electronic and/or hard copies.
• Assists UM Manager with maintaining tracking logs for various departmental activities i.e., appeals, recons, complaints, etc.
  
  

Limitations:

• Your role does not include interpreting clinical data. We do not ask our UM Coordinators to administer clinical questionnaires, nor do we ask them to obtain clinical specifics from anyone requesting authorization of services.
• If a caller wishes to provide clinical specifics that call should be transferred to a UM Nurse or other clinician for that purpose after you have obtained necessary non-clinical information.
• If there is ever any question whatever of a clinical nature that arises out of the performance of your role, refer it to a clinician: a UM nurse, the UM Director, a Medical Director, or the Chief Medical Officer for resolution.
  
  

Salary: 36k-45k

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