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Utilization Coordinator

1 month ago

Albany, United States TenderHeart Health Outcomes Full time
Job DescriptionJob DescriptionTenderheart Health Outcomes is the nation’s leading provider of Incontinence Management Services. They provide quality products and services to help individuals manage their incontinence at home and create healthcare savings in various managed care markets. Through Tenderheart’s value-based payment model with 5 national Managed Care Organizations, they increase healthcare savings and improve patient outcomes. Tenderheart’s service delivery leverages a robust patient and caregiver coaching program and provides high quality products. This support level results in appropriate product utilization and decreased ER and hospital admissions.

Tenderheart uses a case rate that includes the population at risk for incontinence need support. They measure product utilization costs, ER and admissions visits for adverse conditions related to Incontinence. Tenderheart uses a secure data network to share information with Managed Care Organizations and they combat data barriers by housing their own portal system accessible to MCOs. What has contributed to Tenderheart’s successful value-based arrangement is their delivery of services based on member support volume and outcomes versus unit cost as the current Fee for Service arrangement does. This allows the MCO to lower cost through paying only
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Tenderheart Health Outcomes is currently seeking a Utilization Coordinator (This is NOT a remote position)

Job description
· Talks with patients by phone to determine monthly service needs and amounts.
· Talks with patients by phone to establish correct account information.
· Updates patient account as needed
· Updates template as needed.
· Turns off templates according to Company policy when necessary.
· Fills out intake order forms and sends to Intake.
· Adjusts complaints concerning service rendered, referring complaints of service failures to designated departments, leads and managers for investigation.
· Performs advanced file maintenances on patient records and information system.
Maintain monthly case load to make outbound calls or accept inbound calls from patients, service coordinators etc to determine monthly service needs, and updates.
· Communicates with patients of various ages and abilities.
· Conducts courtesy follow-up calls, as required by Company policy and procedure
· Participates in traditional and e-learning programs.
· Performs other duties as assigned.
· Ensures compliance with Company policies and procedures.
· Works effectively with other company employees, managers, and departments.
Performs all job functions with Company Mission, Vision, and Goal Statements in mind.

Experience:
  • Medical office or Healthcare experience (1 year) REQUIRED
  • Utilization review: 1 year (Preferred)
  • CNA, Medical Assistant, Medical Tech (Preferred)
  • Customer Service Experience (Preferred)


Job Type: Full-time
Salary: From $19.00 per hour
Expected hours: 40 per week

Benefits:
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Referral program
  • Vision insurance
Schedule:
  • 8 hour shift
  • Day shift
  • Monday to Friday 8am - 5pm In office 4 Automation Lane, #260. Albany, NY 12205
Our Mission

Tenderheart is committed to delivering exceptional incontinence management through services and products that improve health outcomes and broaden access to care so more patients can live happier, confident, and independent lives.
Our Values
Integrity: We are committed to honesty and trust in everything we think, say and do.
Compassion: We care, we listen, we respond.
Innovation: We create service enhancements that address healthcare challenges.
Equality: We respect people, value diversity, and promote inclusivity.