Job Description
Job Description
About us :
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!
Position is FULLY ONSITE Monday-Friday.
- BILINGUAL IN ENGLISH AND SPANISH IS REQUIRED
Full benefits package offered on the first on the month following date of hire including : Medical, Dental, Vision, 401K plan with a 100% company match!
Our company has doubled size, and we have experienced exponential growth in membership from 2,000 members to over 10,000 members.
Join our winning Solis Team!
Position Summary :
The UM Care Coordinators are instrumental in helping patients receive great care with the attention and follow-up they need for optimal healthcare experiences. This requires a flexible attitude, quick thinking and a caring disposition.
Key Responsibilities :
Scheduling UM Authorization and Determination tasksRefers all services requiring prior authorization to UM Nurse or BH UM Nurse as appropriate Manage determination placementCommunicate with nurses and physiciansReceives and responds to telephonic inquiries from providers regarding status of authorization requests and other questions or concernsGuides practitioners to appropriate referral resourcesHandle inbound calls and answer member and provider questionsConnect with new members via phone and email as requestedCommunicate with members to determine and confirm their needsArrange and coordinate special equipment or therapy for at-home careMaintain files and company information as requiredProvide timely data entry referrals for continuing care as necessaryPerform benefit approvals on services, procedures, and tests that are listed on the UM Coordinator’s approval list. (These services do not require clinical judgment nor are reviewed for medical necessity. This list is reviewed as needed and at least annually for continued use by the UM Coordinator)Process routine referral services that do not require a Prior AuthorizationEnsures timely printing and mailing of pre-certification, authorization and denial lettersAppropriately documents interactions and activities into the UM electronic systemProduces reports from UM electronic system for review and analysis by appropriate Leadership team memberAssist the company care team with goal settingEnsures compliance with all federal, state, and local regulations.Help with member data collection including medical records, HRA, etc.Maintain patient confidentialityRelated duties as neededQualifications :
Post High School graduate courses or equivalent with significant experience in healthcare related customer service position; or equivalent combination of education and experienceInsurance experience in the Medicare and managed care field is preferredKnowledge of CMS guidelines and InterQual is preferredExcellent computer knowledge is required, including proficient knowledge of Microsoft OfficeStrong decision-making and organizational skillsExcellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organizationMust be able to work with little or no supervisionWillingness and ability to function independently and as a team memberWorking Knowledge of medical terminologyAbility to handle multiple functions and prioritize appropriatelyAbility to meet strict deadlinesMust be patient in dealing with an elderly population and sympathetic to hearing or vision deficienciesAbility to read, analyze, and interpret technical procedures or governmental regulationsAbility to define problems, collect data, establish facts, and draw valid conclusionsStrong decision-making, analytical skillsMust be self-motivated, organized and have excellent prioritization skillsMust be able to work well under stressful conditionsMust be able to work in fast paced environmentWhat Sets Us Apart :
Join Solis Health Plans as a Utilization Management Coordinator and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!
