Utilization Management Associate

Plymouth Meeting, PA posted on May 14

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ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization, improves access, educates family members and reduces costs.

Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to home and throughout the first year of life.

Job Role

The Utilization Management Associate (UMA) will assist the ProgenyHealth UM program by providing administration support to the Utilization Review department. This includes: intake, screening and precertification of appropriate healthcare services. They will also be responsible for assisting the Clinical Care Nurses with clerical tasks associated with discharge planning/utilization review functions. The UMA will report to the Supervisor of Utilization Review.

  • Monitor Member eligibility
  • Perform outreach calls to hospitals for follow-up clinical information and discharge info
  • Process new admissions: this includes update of patient demographics; create new case in BabyTrax®; document new case in client system; assign Clinical Care Nurse
  • Communicate verbally and/or written prior auths based on client specifications
  • Skilled Nursing visits: receive request and complete referral form; document in BabyTrax; create outpatient case and assign to appropriate Clinical Care nurse
  • Receive incoming calls for UM and refer to appropriate staff member
  • Adheres to policies, procedures and regulations to ensure compliance and patient safety.
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
  • Provides additional support and project work within the various Care Management areas of accountability as needed.

Qualifications

  • 1 – 3 years of experience in customer service in a healthcare environment.
  • HS diploma or equivalent required. College degree preferred.
  • Insurance/payor experience preferred.
  • Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas as well as interact professionally and effectively with members, clients, and staff from all departments within and outside the company.
  • Problem solving skills with the ability to look for root causes and implementable, workable solutions.
  • Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word.
  • Must be fluent in English. Proficiency in a second language is highly desirable.
  • Must be self-motivated and willing to learn multiple tasks.
  • Must be well-organized and able to prioritize tasks.
  • Must have commitment to excellence in customer service.

Benefits/Culture

Our team is our most important asset. some of the benefits we offer our team are:

  • 401K with company match
  • Medical and dental benefits
  • Long Term Disability
  • Paid Time Off
  • Business Casual Work environment
  • Team orientated events throughout the year

Wage

DOE

Experience

Any

Type

Full-time