What are the responsibilities and job description for the Utilization Management Coordinator position at 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.
The Utilization Management Coordinator is a non-clinical position responsible for processing prior authorization requests from providers to ensure quality clinical outcomes for health plan members. In this position, you will ensure compliance with regulatory guidelines, including timeliness and quality.
Essential Functions
Process prior authorization requests, following internal policies and procedures
Adhere to contractual obligations with internal and external stakeholders
Appropriately forward all prior authorization requests to clinicians for medical review
Assure communication of approved outpatient surgical procedures to medical providers and health plan members
Assist in directing appropriate requests to in-network providers
Participate in the compilation of monthly departmental statistics
Distribute correspondence in adherence with department standards
Maintain appropriate logs, records, and reports as established by the Utilization Management Department
Participate in process improvement activities
Adhere to federal HIPAA guidelines and associated corporate policies and procedures
Other duties as assigned
Job Specifications
Typically has the following skills or abilities:
Bachelor's degree or equivalent related experience
1-2 years of UM healthcare management, and/or training; or equivalent combination of education and experience
Experience in a Health Care Management and/or HMO environment
Experience in utilization review/utilization management
Ability to work in a deadline-driven environment
Basic understanding of LCD/NCD and overall functions of Utilization Management
Excellent organizational skills
Outstanding accuracy in data entry and exceptional attention to detail
Ability to work independently and collaboratively
Strong computer skills and knowledge of MS Office products, including MS Excel, required
Ability to quickly navigate between platforms as necessary
Strong written and verbal communication skills
Understanding of CMS/ACHA guidelines is desirable
Knowledge/experience in NCQA Utilization Management guidelines is highly desirable
VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, disability, or protected veteran status. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here.
iCare is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, gender identity, sexual orientation, disability, or protected veteran status.
Salary : $19 - $22