Coordinator, Intake Utilization Management

Evolent

4d•$20•Remote

About The Position

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. The Coordinator, Intake Utilization Management at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements.

Requirements

A high school diploma or GED is required.
1 – 3 years of experience in a Coordinator role either requesting or submitting prior authorization requests and/or relevant health care experience in claims or appeal & grievances is required.
Ability to read, write and speak the English language fluently with patients and providers.
Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors.
Proficient using computer and Windows PC applications, which includes strong keyboard and navigation skills.
Team oriented, demonstrates a strong work ethic and committed to productivity.
Ability to sit for the majority of shift.
Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment.
High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Responsibilities

Reviewing internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required.
Entering data into a proprietary system generating cases for both the medical and behavioral health reviewers. These requests may be submitted via fax, email, or provider portal.
Working directly with physician’s offices to obtain missing information required to submit a prior authorization request.
Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion.
Addressing requests promptly and courteously, honoring commitments and displays persistence obtaining necessary information to address issues and problems.
Meeting established Utilization Management Intake Objective and Key Results.