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Job Opening details:-
Company Name :- Pennsylvania Health & Wellness
Position Name :-
Company Location :- Camp Hill, PA 17011
Job Category :- General
Full Job Description :-
You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
The Utilization Management Coordinator l may perform duties in one or more of the following areas: Prior Authorization Unit, Hospital Notification Unit, Concurrent Review Unit, Medical Review Unit or Medicare Outreach Team. The Utilization Management Coordinator l supports and coordinates intake activities in Medical Management.
Accurately and effectively applies policies, benefit and eligibility policies, procedures and standards; requesting assistance of supervisor or appropriately licensed health professional when necessary.
Accurately documents all activities as per policy including entry into automated systems.
Meets or exceeds established performance goals including but not limited to service, quality, productivity and turn-around time.
Professionally interacts with customers, acting as a liaison between the beneficiary, provider, facility and Health Plan.
Maintains confidentiality of all PHI in compliance with state and federal law and Health Net Policy.
Reports suspected fraud and abuse as per company policy.
Performs required clerical support duties.
Performs other duties as assigned
Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and development
High School diploma or GED required.
Six months data entry experience.
Intermediate or stronger Excel skills preferred
Experience in a health care, customer service or a managed care setting preferred.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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