Administration

• Provide high-quality support to healthcare providers contacting the call center to initiate referral authorizations or check the status of existing requests
• Serve as a key liaison between providers and internal UM teams, ensuring timely and accurate processing of referral and authorization inquiries in accordance with organizational policies and regulatory guidelines
• Provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members
• Respond promptly and professionally to incoming calls from providers seeking to initiate referral authorizations or obtain status updates on existing requests
• Accurately gather, verify, and enter provider and member information into the appropriate systems
• Review and process referral authorization requests according to established UM protocols, policies, and regulatory requirements
• Collaborate with clinical and administrative staff to resolve issues, clarify requirements, and ensure efficient case management
• Provide clear, concise, and courteous information regarding UM processes, documentation requirements, and referral guidelines
• Monitor call queues and manage multiple tasks to maintain service level agreements and minimize provider wait times
• Identify and escalate complex or urgent cases to the appropriate clinical or supervisory staff as needed
• Maintain thorough documentation of all interactions and transactions in accordance with company standards
• Participate in ongoing training and quality assurance activities to maintain up-to-date knowledge of UM policies and procedures
• Adhere to all applicable privacy, confidentiality, and compliance regulations

Utilization Management Administration Coordinator - Phone Intake

Salary

Job Level

About the role

Requirements

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