Telephonic Intake, Care Specialist - UM (Remote)

Job title: Telephonic Intake, Care Specialist - UM (Remote) in Albany, NY at EmblemHealth
Company: EmblemHealth
Job description: Summary of PositionResponsible for the execution of the non-clinical aspects of the Utilization Management process. Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case. Work seamlessly with other interdisciplinary teams to ensure members’ needs are met. Provide confidential administrative support and assistance to the department in all aspects of daily program operations.Principal Accountabilities

• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
• Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.
• Triage cases and assign receipts to appropriate teams.
• Respond to inquiries from providers, facilities and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards.
• Provide phone management for both incoming and outgoing calls.
• Communicate with members and providers as required.
• Perform other related projects and duties as assigned.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary.
• Actively participate in assigned committees and projects.

Qualifications

• High School Diploma required
• Associates degree or Bachelor’s degree in related field preferred
• At least 1-2 years of previous client-facing or data entry experience in a health care environment
• Additional years of experience/certifications/training may be considered in lieu of educational requirements
• Strong communication skills (verbal, written and interpersonal)
• Ability to work both independently and collaboratively with others
• Previous system user experience in a highly electronic environment
• Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.)
• Knowledge of medical terminology and medical payment
• Ability to prioritize multiple tasks
• Ability and willingness to work weekends and holidays as necessary

Additional Information

• Requisition ID: 1000002506
• Hiring Range: $19.21-$33.75 per hour

Security DisclosureIf you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) - Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.Pay DisclosureAt EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn't account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.EEOC StatementWe value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.Sponsorship StatementEmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.
Expected salary: $19.21 - 33.75 per hour
Location: Albany, NY
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