Experience Inc. Jobs

JOB REQUIREMENTS: Utilitzation Management Coordinator Job Locations US-WI-Madison \| US-WI-Waukesha \| US-WI-La Crosse \| US ID 2024-2049 Category Clinical Services Type Regular Full-Time Overview Do you pride yourself on making work more efficient through organized, thoughtful delegation of tasks and responsibilities? Are passionate about serving the healthcare needs of members, by connecting them with the appropriate parties and resources to meet their needs? Are you dedicated to improving the quality and cultural competence of overall healthcare service delivery, and healthcare self-sufficiency of individuals everywhere? If so, please consider joining our Utilization Management team as a Utilization Management Operations (UM) Coordinator. This role is responsible for delivering an excellent customer experience by collaborating with members and providers to coordinate care and services and serving as the primary contact for Utilization Management inquiries. The UM Operations Coordinator also reviews select prior authorization requests to complete applicable determination processing and triages incoming phone calls and urgent prior authorization requests to appropriate parties within the department. Benefits Work independently while enjoying the benefits of collaborating with a team Make a direct, positive impact on the care and service our members receive Full-time virtual, telecommuting, work from home environment available, if preferred Ideal starting pay range, based on skills and applicable experience: \$24-\$30/hr, plus a robust total rewards package Responsibilities Manage Medicare Prime/Quartz secondary skilled nursing facility prior authorization process, including: Reviewing and processing select prior authorization requests for completeness, reach out to members for more information and to answer their questions, and processing denials for lack of information Review covered benefit requests against medical necessity criteria, policies, and certificates of coverage to process approval and benefit denials Prepare medical records and case notes for approvals, and present denials to Medical Director for further review, as needed Conduct telephonic customer service and problem solving for members and providers regarding authorization requests, hospitalizations, and claims questions Triage outpatient and customer service urgent prior authorization requests Assist with healthcare service coordination - collaborate with RN team to identify and prioritize high needs / risk cases, research and identify appropriate in-network services & assess specialist wait times, and assist members with care coordination and problem solving Coordinate peer to peer requests between physicians Perform Health Plan Transition initial screening/intake for new member coordination of care... For full info follow application link. Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/571097C990D44CEF