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Utilization Management Care Coordinator

2 months ago

Coconut Creek, Florida, United States Centers Plan for Healthy Living Full time

Position Overview:

The Utilization Management Care Coordinator plays a crucial role within a multidisciplinary care team, focusing on the well-being of members enrolled in our Managed Long Term Care program. This position is responsible for facilitating authorization requests for eligible members, ensuring a seamless healthcare experience.

Key Responsibilities:

  • Assist in the prior authorization of services and manage ongoing authorization requests.
  • Update authorizations as necessary, aligning with the member's care plan.
  • Collaborate with healthcare providers regarding authorization processes.
  • Facilitate communication among clinical staff, members, and providers to ensure clarity and efficiency.
  • Act as a liaison and advocate for members and their families, ensuring effective communication with physicians and the care team.
  • Participate in case round meetings and engage in continuous education activities.
  • Ensure compliance with organizational and regulatory standards in all job functions.
  • Perform other related duties as assigned.

Qualifications:

Education:

Required: High School Diploma

Preferred: Bachelor’s Degree

Experience:

Required:

  • Excellent written and verbal communication skills.
  • Proficiency in computer applications.
  • Strong ability to manage multiple tasks effectively.

Preferred:

  • Experience in a managed care setting.

Technical Skills:

Preferred:

  • Proficiency in Microsoft Office applications.

Certifications:

Required: None

Physical Requirements:

Must be capable of operating a computer and telephone.

The above information outlines the general nature and level of work expected from individuals in this role. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required.

Commitment to Diversity:

Centers Plan For Healthy Living values the diverse backgrounds and experiences of our workforce. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by law.