Utilization Management Intake Coordinator MA
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Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
Workforce Scheduling
Remote
Job Summary
The Utilization Management Intake Coordinator supports clinical, management, and client activities, comprising the Utilization Management (UM) program. Incumbent must be proficient in all UM processes such as pre-authorizations, claim reviews, triage and case assignments.
Requirements
EDUCATION
High School diploma or equivalent.
Associate's degree in Human... Service, Psychology or related field.
LICENSING/CERTIFICATION
Certified Medical Manager (CMM) designation preferred.
EXPERIENCE
Minimum two (2) years' customer service/call center experience.
Minimum one (1) year experience in a Behavioral Health Care field preferred.
Experience with Medicare Advantage Utilization Management preferred.
Experience working for a large healthcare insurance organization preferred.
Experience with PCA program or Human Services/Healthcare intake and referral a plus.
ESSENTIAL SKILLS & ABILITIES
Customer Service
Personal Computer (PC) Software
Typing 40 wpm
Data Entry
Time Management
Professional Etiquette
Multitasking
Logical Thinking
Oral & Written Communication
Strong Interpersonal Skills
Analyze Information
Highly Organized
Detail Oriented
Highly Motivated Self-Starter
Proficiency with MS Office Suite (Word, Excel, PowerPoint including web-based computer applications required).
Typing skills at 40 wpm. Ability to maintain proficient speed of typing while obtaining verbal information over the phone.
Ability to Work Independently or as a Team.
Skills
Customer Service, Data Entry, Detail-Oriented, Interpersonal, Logical Thinking, Microsoft Office (Word, Outlook, Excel, PowerPoint), Multitasking, Oral and Written Communication Skills, Organized, Professional Etiquette, Self-Starter, Time Management
Responsibilities
Attends and actively participates meetings as required., Collaborates with social worker and/or care manager to develop action plan., Facilitates communication between all parties (patients, families, colleagues, and community-based organizations) as needed., Gathers clinical information regarding cases and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review)., Maintains and updates tracking databases., May assist with case referral process, complex cases member engagement and scheduling., May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager., Other duties as assigned., Prepares reports and documents clear and concise notes on all actions., Promotes engagement and high enrollment with members for case management to help achieve health goals., Provides information regarding network providers or general program information when requested., Works to identify social determinants of health impacting patient's health and general well-being.
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment
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