- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit ... verification, gathering necessary clinical information from electronic medical record, and timely communication with members, providers and facility staff. Candidates should possess knowledge of third-party reimbursement regulations and medical terminology.… more
- Centers Plan for Healthy Living (Margate, FL)
- …plans they need for healthy living. 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. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in completing… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case ... Managers, support staff, insurance payers, and post-discharge vendors to ensure safe, timely, and efficient transitions of care. This coordination not only supports optimal patient outcomes but also helps ensure appropriate hospital reimbursement for services… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing ... HCPC codes + Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred + Knowledge of ICD-10, HCPCS… more
- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. ... The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer...Military referral processes, MOUs with MTFs, and referral and UM policies. + Answers questions or contacts MTFs and/or… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Health Support Coordinator Location: Remote Career Area: Customer Service/Operations About Blue Cross and ... to make a difference, join us. The Impact You Will Have The Health Support Coordinator (HSC) is a member of the Blue Cross Blue Shield of Minnesota (BCBSMN) Care… more
- Saint Francis Health System (Tulsa, OK)
- …and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details ... to the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager. Reviews eligibility and benefits of patients, matching the level of… more
- Fallon Health (Worcester, MA)
- …for incoming calls from the multiple ACD lines for the UM department addressing and/or referring customer (provider/member) calls/inquiries, provide direction ... Manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application...focus toward excellent customer service. In addition, the Service Coordinator will attain the targets for a customer service… more
- University of Michigan (Ann Arbor, MI)
- Community Outreach Coordinator (TERM-LIMITED) Apply Now **How to Apply** A cover letter is required for consideration for this position and should be attached as the ... and Rehabilitation (PM&R) seeks a qualified candidate for the position of Community Outreach Coordinator to join our team. This role will support the work of the… more
- Dignity Health (Oxnard, CA)
- **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients ... requiring these services. The RN Care Coordinator performs this role to meet the individual's health...Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed care and… more