Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Position Summary:

The Utilization Management Coordinator reports to the Director of Claims. This position is responsible for coordinating the appeal activities and UM process which includes initiating Case Management, requesting Pre-certification, submitting Medical Reviews, and Independent Dispute Resolution. The successful candidate(s) will bring the utmost level of service, professionalism, and commitment to this position.

Essential Duties and Responsibilities:

• Gather, analyze, and report information regarding member and provider appeals.
• Prepare and respond to written inquiries from employer, members, and providers in accordance with Department of Labor guidelines and applicable summary plan document language.
• Maintain files and logs for all appeals.
• Interface with various managed care organizations, UM, and cost containment Vendors to coordinate reviews for medical necessity including pre-determinations and retrospective reviews.
• Review submissions by the Claims Department to determine appropriateness of services through established UM guidelines, triology, summary plan document review, etc.
• Actively participate in meetings including presentation of reports, statistics, etc.
• Perform other related duties and participate in special projects as assigned.

Benefits:

• Paid time off
• Paid Holidays
• Medical, Dental and Vision Insurance
• Basic Group Life, Short Term and Long Term Disability
• Voluntary Life, Critical Illness and Accident Coverage
• 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.

Knowledge, Skills and Abilities:

• Strong administrative/technical skills; Comfortable working on a PC using Microsoft Office, Microsoft Teams, and telephones efficiently.
• Excellent communication skills (spoken and written); comfortable talking on the phone for extended periods of time and replying to emails in a timely manner.
• Trustworthy and accountable behavior, capable of viewing and maintaining confidential personal information daily.
• Willingness to routinely, reliably come to work on schedule and adjust shift/scheduling based on the needs of the organization (including occasional paid overtime)
• Education: High School Diploma or General Education Development (GED) equivalent.

General Expectations:

• Always present a positive image of Consociate.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed
• Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Client Services Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees, and applicants.

Physical and Mental Abilities:

• Ability to perform sedentary work for extended periods of time.

• Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of team members.

• Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Working Conditions:

• This is a fully remote position.

• If work is performed offsite, location must be HIPAA compliant.