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Medical Management Care Coordinator, Utilization Management

VNS Health
paid time off, tuition reimbursement
United States, New York, New York
220 East 42nd Street (Show on map)
May 02, 2025
OverviewCollects specific data in the medical management information system for the clinical staff. Resolves authorization issues as well as troubleshoots, researches and resolves related issues in a timely and efficient manner. Works under general supervision. Job Description What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at20daysof paid time offand 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life andDisability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities Interdisciplinary network of colleagues through the VNS Health Social Services Community ofProfessionals. What You Will Do Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools. Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication. Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved. Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions. Provides triage and management of calls ensuring that established call performance targets are consistently achieved. Provides feedback to leadership regarding training needs Collaborates with management to determine the best approach to service customers, handle repeat vendor issues and other job-related matters to maximize and improve delivery, billing and payment of goods and services. Protects the confidentiality of member information and adheres to company policies regarding confidentiality. Participates in special projects and performs other duties as assigned. Qualifications Education: High School Diploma or equivalent Required Work Experience: Minimum of two years of experience in a customer service role Required Excellent oral and written communication skills Required Advanced personal computer skills, including Word, Excel or Access Required Utilization Management experience Preferred Compensation$20.98 - $26.23 Hourly About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us-we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.