Assess referred concurrent denials and determine next steps for resolution.
Review medical record documentation to support denial management strategies.
Advocate for patients to ensure coverage and reimbursement.
They are currently looking for a Utilization Management Coordinator. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery.
Evaluates certification requests by reviewing the group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed to complete the call.
Cottingham & Butler sells a promise to help their clients through life’s toughest moments. Their culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Conducts outbound and inbound calls to educate patients about Advanced Care Planning ultimately scheduling an appointment.
Overcome Patient concerns and objections by clearly articulating the importance of Advanced Care Planning and how it benefits their healthcare journey.
Respond to multimodal and outgoing calls, texts, and emails by providing direction to Patients’ questions and/or concerns.
Aledade exists to empower independent primary care by creating value-based contracts across a wide variety of health plans. They were founded in 2014 and have become the largest network of independent primary care in the country. They have a collaborative, inclusive, and remote-first culture.
Respond to inquiries, providing expert guidance and support via in-app chat and phone.
Use AI-powered tools to efficiently research plan details and synthesize information for users.
Conduct comprehensive comparisons of Medicare Advantage plans, ensuring users understand their options.
Propel builds technology that strengthens the social safety net in America. Over 5.5 million Americans trust Propel today and they've grown revenue 35% YoY, reinventing entire benefit categories, including Medicare, around the real needs of low-income Americans.
Support medical policy functions by providing medical coding and system configuration.
Perform coding analysis and utilization reporting to recommend updates to medical policies.
Participate in cross-functional meetings to align with enterprise strategic priorities.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. They are motivated by the well-being of their members and committed to sustainability and innovation.
Responsible for establishing and maintaining positive relationships with various providers.
Drives provider engagement and communication, supporting network development.
Manages provider performance, shares data, and supports the implementation of quality initiatives.
CommonSpirit Health has over 700 care sites across the U.S., offering services from clinics and hospitals to home-based and virtual care. They are committed to building healthy communities and advocating for those who are poor and vulnerable.