The Utilization Management department's preservice outpatient team is seeking a team member to provide assistance to the clinical team with authorization requests. The intake coordinator serves as a support to health plan teams by completing administrative tasks and coordinating activities such as answering telephones, taking messages, and answering routine questions. In addition, the role composes, types, and distributes meeting notes, routine correspondence, presentations, billing, reimbursement, or monthly reports. May maintain master copies of company policy and procedure manuals, keeping them up-to-date. This role manages all mailings to members and is responsible for necessary correspondence. Documents all member/provider interactions in member database software per expected workflow. Requires strong verbal and written skills geared toward communicating by phone, in writing, and in person. Must project a positive and professional image and be able to interact compassionately with members on a one-on-one basis, anticipating their needs through careful listening and patience. Must be highly organized and able to handle multiple tasks under constant pressure. Microsoft Office skills are required. Awareness of when and how to access additional resources to meet member needs is essential. For individuals supporting clinical areas, additional duties include: utilization management performing resource benefit policy management, triaging inbound and outbound calls, processing intake requests (prior authorizations), completing data entry, and assigning cases to appropriate clinical team members. Supports medical management programs and operations. Case management leads the initial intake and review of members eligible for medical and behavioral health case management services. Assigns members to teams based on risk score and clinical rules. Provides support to case managers by scheduling telephonic visits with members, completing initial clinical screening questionnaires, and facilitating correspondence with members, including educational materials and other resources. Reviews Sanford Health Plan member risk score reports. For individuals supporting non-clinical areas, additional duties may include but are not limited to: tracking metrics/dashboards; filing details from workshops, events, or other assigned functions with CMS and providing compliant materials specific to the event. Manages correspondence/communications with potential clients/customers and routes prospect calls for assistance. Schedules meetings and calls for assigned staff members when needed. Coordinates with Marketing for event mailings.
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Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED