We are searching for a brilliant Utilization Management Coordinator to join our exceptional team at Quartz in Madison, WI.
Growing your career as a Full Time Utilization Management Coordinator is an amazing opportunity to develop exceptional skills.
If you are strong in planning, teamwork and have the right drive for the job, then apply for the position of Utilization Management Coordinator at Quartz today!
Do you pride yourself on making work more efficient through organized, thoughtful delegation of tasks and responsibilities? Are you passionate about serving the healthcare needs of members, by connecting them with the appropriate parties and resources to meet their needs? Are you dedicated to improving the quality and cultural competence of overall healthcare service delivery, and healthcare self-sufficiency of individuals everywhere? If so, please consider joining our Utilization Management team as a Utilization Management (UM) Coordinator. This role will be delivering an excellent customer experience by engaging with members and providers to coordinate care and services and serving as the primary contact for Utilization Management inquiries. The UM Coordinator also reviews select prior authorization requests to complete applicable determination processing and triages incoming phone calls and urgent prior authorization requests to appropriate parties within the department.
Benefits Work independently while enjoying the benefits of collaborating with a team Make a direct, positive impact on the care and service our members receive Full-time work from home environment available, if preferred Ideal starting pay range, based on skills and applicable experience: $24-$30/hr, plus a robust total rewards package Manage Medicare Advantage/DSNP and Badger Care/SSI prior authorization process, including: Review and process select prior authorization requests for completeness, reach out to members for more information and to answer their questions, and processing denials for lack of information for appropriate Line of Business Review covered benefit requests against medical necessity criteria, policies, and certificates of coverage to process approval and benefit denials Prepare medical records and case notes for approvals, and present denials to Medical Director for further review, as needed Conduct telephonic customer service and problem solving for members and providers regarding authorization requests, hospitalizations, and claims questions Triage outpatient and customer service urgent prior authorization requests Assist with healthcare service coordination - collaborate with RN team to identify and prioritize high needs / risk cases, research and identify appropriate in-network services & assess specialist wait times, and assist members with care coordination and problem solving Coordinate peer to peer requests between physicians Medical documentation and reporting - send appropriate notifications to members, providers, and facilities according to established processes & policies Associate degree or equivalent work experience in a health-related field 3+ years of experience working in health plan or healthcare-related operations role Valid Driver's License and verifiable good driving record and reliable transportation, with the ability to travel, as necessary, to attend off-site meetings on a regular basis LPN preferred Knowledge of medical terminology, including ICD-10 and CPT/HCPCS coding (CPC certification preferred) Electronic health record experience preferred (i.e. EPIC) This full-time position may work remotely, or from one of our offices located in Madison, WI or Onalaska, WI. Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.
Quartz offers an excellent benefit and compensation package, opportunity for career advancement and a professional culture built upon the foundations of Respect, Responsibility, Relationships & Resourcefulness. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check and drug screening.
Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
Benefits of working as a Utilization Management Coordinator in Madison, WI:
? Company offers great benefits
? Advancement opportunities
? Competitive salary
? Remote Work opportunity
