Care Specialist, UM Intake

Emblem Health•New York, NY

40d

About The Position

Responsible for the execution of the non-clinical aspects of the Utilization Management process. Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case. Work seamlessly with other interdisciplinary teams to ensure members' needs are met.Provide confidential administrative support and assistance to the department in all aspects of daily program operations.

Requirements

High School Diploma required
At least 1-2 years of previous client-facing or data entry experience in a health care environment
Additional years of experience/certifications/training may be considered in lieu of educational requirements
Strong communication skills (verbal, written and interpersonal)
Ability to work both independently and collaboratively with others
Previous system user experience in a highly electronic environment
Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.)
Knowledge of medical terminology and medical payment
Ability to prioritize multiple tasks
Ability and willingness to work weekends and holidays as necessary

Nice To Haves

Associates degree or Bachelor's degree in related field preferred

Responsibilities

Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.
Triage cases and assign receipts to appropriate teams.
Respond to inquiries from providers, facilities and members.
Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards.
Provide phone management for both incoming and outgoing calls.
Communicate with members and providers as required.
Perform other related projects and duties as assigned.
Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
Support communication and coordination with delegated entities, as necessary.
Actively participate in assigned committees and projects.