Coordinator, Utilization Management (IDD)

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

POSITION SUMMARY

The Utilization Management (UM) Coordinator (CIDD) supports the comprehensive coordination of medical services including intake, screening, and referrals to Florida Community Care (FCC) care management and promotes/supports quality effectiveness of healthcare services. The UM Coordinator handles intake calls from members or providers regarding services, they research information and then refer to appropriate medical staff. The UM Coordinator approves services that do not require a medical review in accordance with the prior authorization grid and supports the administration of the precertification process in compliance with various laws and regulations. The UM Coordinator places outbound calls to providers under the direction of medical management nurses to obtain clinical information for review of medical authorizations.

 ESSENTIAL FUNCTIONS

• Performs intake of calls from members or providers regarding services via telephone, fax, web portal. Screens requests for appropriate referral to medical services staff.
• Utilizes internal systems to build, research and enter member information.
• Approve services that do not require a medical review in accordance with the prior authorization grid.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Communicates internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, plan sponsors, and third-party payers as well as member, family, and health care team members respectively). Places outbound calls to providers under the direction of medical management nurses to obtain clinical information for review of medical authorizations.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Communicates with care managers when processing transactions for members active in this program.
• Supports the administration of the precertification process in compliance with various laws and regulations, URAC and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• Performs other duties as required or assigned.  

EDUCATION AND EXPERIENCE

• High school diploma or G.E.D.
• 2-4 years of experience as a medical assistant, office assistant or other clinical experience. 
• Managed care experience preferred (e.g., Medicaid, Medicare).
• Experience working with the developmentally disabled community preferred. 

REQUIRED SKILLS

• All employees shall meet specified training program including Compliance/Privacy Regulations and attend at a minimum one (1) hour of Compliance/Privacy educational training annually, as required by Florida Community Care.
• All employees shall meet Risk Management Regulations and attend at the minimum one (1) hour of Risk Management education and training within the first thirty (30) days of employment and as required by law or Florida Community Care; and, for that non-physician in clinical direct care delivery services, annually thereafter.
• All employees, if duly licensed in the State of employment, and said license is part of requirement of their position with Florida Community Care, shall maintain in good standing and current state licensure. 
• All employees are required to maintain confidentiality, protect privacy, comply with PHI regulations, and report violations.  

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.