Description

The Prior Authorization / Utilization Review 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 assure compliance with regulatory guidelines, including timeliness and quality.

RESPONSIBILITIES / SKILLS:

• Process prior authorization requests, following internal policies and procedures.
• Outstanding accuracy in data entry and exceptional attention to detail.
• Adheres to contractual obligations with internal and external stakeholders.
• Appropriately forwards all prior authorization requests to clinicians for medical review.
• Assures communication of approved outpatient surgical procedures to medical providers and health plan members.
• Assists in directing appropriate requests to in network providers.
• Participates in compilation of monthly departmental statistics.
• Distributes correspondence in adherence with department standards.
• Maintains appropriate logs, records, and reports as established by Utilization Management Department.
• Participates in process improvement activities.
• Adheres to federal HIPAA guidelines and associated corporate policies and procedures.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively.

The above is an overview of expected responsibilities. Other duties may be assigned.

iCare Health Solutions

iCare Health Solutions is a Health Services Organization that delivers clinically integrated and coordinated eye care solutions. Our solutions embrace well-care by proactively maintaining and measuring patient health through our primary eye care model. As part of this responsibility, we are contracted by multiple national and regional health plans to provide eye care services to their members.

We seek employees who are creative-thinkers with fresh insights, who thrive in a dynamic, customer-centric environment. We value diversity and recognize that the unique qualities of individuals contribute to our strength

Minimum Qualifications:

• Prior experience in utilization review / utilization management
• Knowledge/experience in NCQA Utilization Management guidelines is highly desirable.
• Basic understanding of LCD/NCD and overall functions of Utilization Management.
• Demonstrate excellent organizational skills.
• Strong computer skills and knowledge of MS Office products, including skills in MS Excel required. Ability to quickly navigate between platforms necessary.
• Strong written and verbal communication skills in English
• Background check in accordance with local and federal regulations

Experience:

• Healthcare experience in a Health Care Management and/or HMO environment.
• 1-2 years of UM healthcare management, and/or training; or equivalent combination of education and experience.
• Comfortable in a deadline driven environment
• Proficiency in MS office products
• Understanding of CMS / ACHA guidelines is desirable

Education:

• High school diploma or general education degree (GED)
• Bachelor’s or equivalent related experience
• Clinical license is not required for this position.

Location:

Tampa, Florida

Job Type: Full-time- Remote

Benefits:

• Health insurance
• Dental insurance
• Retirement plan
• Paid time off

Pay Frequency:

• Bi weekly

Typical end time:

• 5PM (flexible)

Typical start time:

• 8AM (flexible)

Work Location: One location

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