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Lead, Care Coordinator
NeueHealthLead Utilization Management Coordinator at NeueHealth managing the UM Coordinator team and authorizations. Ensuring compliance and operational efficiency in healthcare service delivery.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management and Prior Authorization processes, with a strong focus on compliance with regulatory standards and effective team leadership. Proficient in training, mentoring, and supporting team members while ensuring timely processing of authorization requests.
Highest-signal resume keywords
Utilization ManagementPrior AuthorizationTeam LeadershipBilingual (English/Spanish)Healthcare Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Authorization ProcessingDocumentation ReviewQuality ImprovementMetrics TrackingRegulatory Compliance
Soft Skills
CoachingCommunicationCollaborationProblem-SolvingMentoring
Tools & Technologies
Utilization Management System
Certifications & Qualifications
Medical Assistant Certification
Industry Keywords
Health PlanManaged CareNCQACMSHIPAA
About the role
Key responsibilities & impact- 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.
Requirements
What you’ll need- High School Diploma or equivalent required; Associate's degree in Healthcare Administration or a related field preferred.
- Minimum of 3–5 years of experience in a health plan or managed care environment.
- At least 2 years of Utilization Management, Prior Authorization, or Case Management support experience required.
- Previous experience serving as a team lead, trainer, mentor, or in an informal leadership role strongly preferred.
- Demonstrated ability to interpret health plan benefits and authorization guidelines.
- Bilingual (English/Spanish) required.
- Medical Assistant certification or other healthcare certification preferred.
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Flexible work arrangements
- Professional development opportunities