Coordinator, UM Intake

Evolent

4d•Remote

About The Position

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. 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.

Requirements

A high school diploma or GED
1 – 3 years of experience in a Coordinator role either requesting or submitting prior authorization requests, or relevant health care experience in claims or appeal & grievance.
Previous background/experience with Oncology.
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 in using computer and Windows PC applications, which includes strong keyboard and navigation skills.
Team-oriented, demonstrates a strong work ethic and is committed to productivity.
Demonstrated ability to meet established goals while balancing a workload and prioritizing assignments in a remote environment.
High speed internet over 10 Mbps and the ability to plug in directly to the home internet router.

Responsibilities

Serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements.
Review internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required.
Enter data into a proprietary system to generate cases for both medical and behavioral health reviewers.
Work directly with physician’s offices to obtain missing information required to submit a prior authorization request.
Submit IT tickets to address barriers to generating cases for clinical review and follow the ticket through to completion.
Address requests promptly and courteously, honoring commitments, and display persistence in obtaining necessary information to address issues and problems.
Meet established Utilization Management Intake Objectives and Key Results.