Utilization Management Coordinator
Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
The UM Coordinator will assist in the process of CHC Providers obtaining authorization, ensuring accurate data entry in the Utilization Module, and assist with requested services/treatments that do not require clinical decision making. Handles entry of all notifications of admission, transfers, and assist with the data entry of requests for home health, and durable medical equipment. They will use analytical and professional skills to answer phone calls and screen documents for key information necessary for clinical staff and Medical Directors. This will assist them in making informed medical decisions regarding admissions, transfers, services and transports. They will also support regulatory timelines and CHC guidelines.
- Two years College Education, preferred
- Three - five years experience in Referrals/Authorizations. At least one year insurance related experience in a managed care environment. Experience in Medical coding preferred
- Analytical, Medical Terms,
- MS Word, MS Excel
- Able to work independently under general instructions.
- Above Average Verbal (Heavy Public Contact), Writing /Composing (Correspondence/Reports)
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Job Status: Full Time
Job Reference #: 166036