Senior UM Coordinator

About The Role
Brighton Health Plan Solutions provides Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by performing data collection, data entry, and effectively communicating with Nurse reviewers and leaders’ employers and claimants regarding their requests for preservice, prospective, and concurrent reviews. The Senior UM Coordinator reports to the Manager, Utilization Management and/or Supervisor, UM Coordinators.
Primary Responsibilities

• Partner with leadership in cross training team members in all non-clinical departmental functions.

• Create cases within the clinical platform while adhering to policies, procedure, and defined workflows.
• Support Clinical staff as needed with administrative needs including but not limited to outbound fax requests, telephonic communications, and reporting compilation.
• Data entry of required clinical documentation as received via fax or portal submissions.
• Telephonic interactions with physicians and/or representatives to acquire information or relay medical determination updates.
• Function as a SME (subject matter expert) for the UM Coordinator Team.
• Support training of new hires.
• Collaborate on the creation and implementation of workflows for the UM Coordinator team.
• Assist in supporting escalations if needed from providers and members.
• Perform Ad-Hoc projects and support departmental initiatives as needed.

Essential Qualifications

• Strong PC skills (Documentation systems, faxing systems, Microsoft Applications)
• Excellent organizational skills including written and oral communication skills.
• Ability to work independently and as a team.
• Minimum of one years’ experience in utilization management functions.
• Understanding of utilization management functions strongly preferred.
• Bilingual preferred, but not required.
• Strong customer service skills required.
• History working in medical records review, healthcare, or managed care organizations.

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

Annual Salary Range: $50,000 - $54,000

The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.
JOB ALERT FRAUD:  We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected]