Centers Plan for Healthy Living

  • Utilization Management Care Coordinator

    Job Locations US-NY-Staten Island
    Posted Date 12 months ago(10/24/2017 4:26 PM)
    ID
    2017-1240
    # of Openings
    1
    Category
    Care Management
  • Overview

    New CPHL Logo

     

     

     

    JOB SUMMARY:

     

    The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members

    Responsibilities

    PRIMARY RESPONSIBILITIES:

     

    • Assists in the prior authorization of services and ongoing authorization requests
    • Assists in completing authorization updates as needed based on the care plan of the member
    • Coordinates with providers regarding authorization activities
    • Coordinates communication between authorization clinical staff, members and providers as needed
    • Act as liaison and member advocate between the member/family, physician(s) and the care team to ensure timely and effective communication in regards to the member’s care
    • Participates in case round meetings and on-going education activities
    • Ensures that all job responsibilities are carried out in compliance with CPHL and State and Federal regulations
    • Other assigned duties

    Qualifications

    Education and Experience:

     

    Education

     

    Required:   HS Diploma

     

    Preferred:  Bachelor’s Degree

     

    Type of Experience

                                         

    Required:   

    Strong written and verbal communication skills

    Computer proficiency

    Strong multi-tasking abilities

     

     

     

    Preferred: 

    Experience working within a managed care environment

     

    Specific Technical Skills

    Preferred:    Computer proficiency in Microsoft Office applications

     

    Certifications/Licensure:

    Required:    None

               

     

    SCOPE INFORMATION

    # Direct Reports:         0         

               

     

    Physical Requirements:

    The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

    • Must be able to operate a computer and telephone

     

     

    The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

     

     

     

     

     

     

     

     

     

     

     

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