Support Coordinator - Utilization Management

Healthfirst New York , NY 10007

Posted 6 days ago

The Support Coordinator is responsible for assisting the care/case managers with non-clinical activities such as creating cases and events; providing telephonic outreach to members, providers and community-based organizations; handling member mailings; faxing clinical requests and Individual Health Care Plans on behalf of the care/case managers. The Support Coordinator is assigned to a specific clinical team (such as Care Management, Utilization Management, Behavioral Health, etc.) and may have additional departmental responsibilities.

  • Handles calls to and from members to assist with benefit questions/issues, schedule appointments, and screen assessments to identify risk factors which need closer intervention.

  • Handles calls to and from providers regarding authorizations, referrals, visits, tests, and faxed care plans.

  • Documents accurate member information in compliance with our internal procedures.

  • Manages an average caseload of 200 cases.

  • Timely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomes.

  • Escalates calls as necessary

  • Additional duties as assigned.

Minimum Qualifications:

  • High School diploma or GED.

Preferred Qualifications:

  • Basic Microsoft Word and Excel skills.

  • Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese.

  • Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department.

  • Demonstrated ability to document calls into a computer system.

  • Knowledge of medical terminology.

Regulatory or Compliance activities: n/a

License or Certification: n/a

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Utilization Management Nurse 2 Northeast Region

Humana Inc.

Posted Yesterday

VIEW JOBS 3/20/2019 12:00:00 AM 2019-06-18T00:00 Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsibilities The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Required Qualifications * Active RN license in the state(s) in which the nurse is required to practice * Prior clinical experience preferably in an acute care, post-acute, skilled or rehabilitation clinical setting * Must have good typing skills and proficiency using MS Office Word, Excel and Outlook * Ability to work independently under general instructions and with a team * Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required Preferred Qualifications * Education: BSN or Bachelor's degree in a related field * Health Plan experience * Previous Medicare/Medicaid Experience a plus * Call center or triage experience * Previous experience in utilization management strongly preferred * Previous experience with Milliman (MCG) * Discharge planning and/or home health or rehab Additional Information * Hours for this role are: Monday-Friday 8am-5pm EST or CST Scheduled Weekly Hours 40 Humana Inc. New York NY

Support Coordinator - Utilization Management