NeueHealth

Care Coordinator

• Lead the daily operations and workflow of the UM Coordinator team to ensure timely processing of authorization requests.
• Serve as the primary resource and subject matter expert for UM Coordinators, providing guidance, coaching, and support on complex cases and operational issues.
• Assist leadership with onboarding, training, mentoring, and ongoing development of new and existing UM Coordinators.
• Monitor team productivity, work queues, turnaround times, and workload distribution to ensure compliance with regulatory and organizational standards.
• Receive, review, and process incoming requests for authorization of medical services.
• Coordinate with providers, members, and internal clinical staff to obtain required documentation for utilization reviews.
• Enter authorization requests, updates, and determinations into the utilization management system accurately and efficiently.
• Track and monitor pending authorizations to ensure timely processing and communication of decisions.
• Collaborate with UM nurses and physicians to facilitate medical necessity reviews and ensure adherence to clinical guidelines.
• Communicate authorization determinations (approvals, modifications, or denials) to providers and members within required regulatory timeframes.
• Perform quality reviews of authorization documentation and identify opportunities for process improvement.
• Assist leadership with audits, regulatory readiness, accreditation activities, and quality improvement initiatives.
• Escalate complex operational or system issues to management and recommend process improvements to enhance efficiency and service quality.
• Act as a liaison between internal departments, providers, health plans, and external vendors to resolve issues and improve collaboration.
• Assist with reporting, metrics tracking, and monitoring of key performance indicators (KPIs).
• Promote compliance with NCQA, CMS, state and federal regulations, health plan requirements, and organizational policies.
• Maintain strict adherence to HIPAA and confidentiality standards.

Lead, Care Coordinator

QA Engineer

• Write and manage software integration and regression test cases.
• Develop and maintain the testing infrastructure for core healthcare products.
• Leverage AI tools to accelerate and automate testing.
• Collaborate with cross-functional teams to integrate products with business processes and backend infrastructure.
• Work on a variety of products, demonstrating flexibility and adaptability.
• Ensure the scalability, performance, and security of developed solutions.
• Participate in code reviews, contributing to and maintaining high code quality.
• Stay up-to-date with emerging technologies and industry best practices.

Software Tester

Systems Engineer

• Collaborate with business financial stakeholders to understand analytics, accounting, reconciliation, planning, budgeting, forecasting, and enterprise data management needs; develop plans to address those needs; and deliver solutions that support business objectives.
• Provide functional and technical support for Oracle Financials and Oracle EPM Cloud applications, including ARCS, EPBCS, and EDMCS.
• Support Oracle EPM processes including account reconciliations, transaction matching, planning and budgeting cycles, forecasting, reporting, metadata management, hierarchy maintenance, data governance, and integration support.
• Partner with Accounting and Finance teams to support ARCS processes including reconciliation compliance, profiles, formats, match types, data loads, period close activities, dashboards, reporting, and issue resolution.
• Partner with Financial Planning & Analysis teams to support EPBCS processes including planning forms, business rules, calculations, data maps, reporting, security, scenario/version management, and annual budget and forecast cycles.
• Support EDMCS processes including enterprise metadata governance, hierarchy and dimension management, request workflows, subscriptions, mappings, validations, and integrations with Oracle Financials, EPM, and downstream systems.
• Support and understand integrations in and out of Oracle Financials and Oracle EPM applications, including data loads, extracts, metadata integrations, automation processes, and reconciliation between source and target systems.
• Lead and facilitate business analysis and requirements development and management processes, including eliciting, documenting, analyzing, modeling, prioritizing, validating, and tracing requirements.
• Lead IT test procedures, prepare test plans, test cases, and scripts, and facilitate system integration testing and user acceptance testing for Oracle Financials and Oracle EPM enhancements, releases, and projects.
• Collaborate with product partners, system owners, and subject matter experts to gather requirements for new systems, enhancements, integrations, reports, dashboards, and projects within the functional area.
• Lead design sessions and prototype new systems, enhancements, and projects for the purpose of improving business processes, automation, controls, data quality, and information flow.
• Document and diagram existing and future-state system and business processes related to Oracle Financials, ARCS, EPBCS, EDMCS, integrations, reporting, and close/planning cycles.
• Translate functional business requirements into technical requirements while working with system architects, software engineers, integration teams, managed service providers, and Oracle support partners.
• Collaborate with business and technology partners to perform cost-benefit and return on investment analyses for proposed systems, enhancements, and process improvements to aid management in making implementation decisions.
• Ensure compatibility, interoperability, security, and data integrity of enhancements and projects within current system and business processes.
• Monitor Oracle Cloud updates and releases, assess business impact, coordinate testing, and support adoption of new features and capabilities across Oracle Financials and Oracle EPM applications.
• Support reporting and analytics needs across Oracle Financials and Oracle EPM, including operational reporting, reconciliation reporting, planning and forecast reporting, and executive-level financial reporting.
• Support Oracle Narrative Reporting capabilities as needed; experience with Narrative Reporting is preferred but not required.
• Other duties as assigned.

Lead, Care Coordinator

Software Tester

Business Systems Analyst, Oracle EPM