Utilization Management Coordinator

The Utilization Management Coordinator is a non-clinical position, responsible for processing prior authorization requests from providers to assure quality clinical outcomes for health plan members. In this position, you will ensure compliance with regulatory guidelines, including timeliness and quality.

Essential Functions

Process prior authorization requests, following internal policies and procedures

Adhere to contractual obligations with internal and external stakeholders

Appropriately forwards all prior authorization requests to clinicians for medical review

Assure communication of approved outpatient surgical procedures to medical providers and health plan members

Assist in directing appropriate requests to in-network providers

Participate in the compilation of monthly departmental statistics

Distribute correspondence in adherence with department standards

Maintain appropriate logs, records, and reports as established by Utilization Management Department

Participate in process improvement activities

Adhere to federal HIPAA guidelines and associated corporate policies and procedures

Job Specifications

Typically has the following skills or abilities:

Two to four years of UM healthcare management, and/or training; or equivalent combination of education and experience

Experience in a Health Care Management and/or HMO environment

Experience in utilization review/utilization management

Ability to work in a deadline-driven environment

Basic understanding of LCD/NCD and overall functions of Utilization Management

Excellent organizational skills

Outstanding accuracy in data entry and exceptional attention to detail

Ability to work independently and collaboratively

Strong computer skills and knowledge of MS Office products, including MS Excel required

Ability to quickly navigate between platforms as necessary

Strong written and verbal communication skills

Understanding of CMS/ACHA guidelines is desirable

Knowledge/experience in NCQA Utilization Management guidelines is highly desirable

VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, disability, or protected veteran status. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here.