Utilization Management Director jobs in Saint Louis, MO

ProgenyHealth is a leading provider of care management solutions for maternal and infant populations. We partner with health plans and their obstetric, perinatal, and neonatal providers to work collaboratively in developing a plan of care specific to the needs of each member/family – from prenatal care to delivery to admission to the intensive care nursery until they are safely transitioned from the hospital, up to the first year of an infant’s life. Our program promotes appropriate utilization, improves access, educates members and their families, addresses social determinants of health, reduces costs, and improves outcomes.

Job location: This position may be performed remotely – candidates outside of the Eastern PA area will be considered.

Job Role

The Utilization Management Associate (UMA) will assist the ProgenyHealth UM program by providing administration support to the Utilization Review department. This includes: intake, screening and precertification of appropriate healthcare services. They will also be responsible for assisting the Clinical Care Nurses with clerical tasks associated with discharge planning/utilization review functions. The UMA will report to the Supervisor of Utilization Review.

• Monitor Member eligibility
• Perform outreach calls to hospitals for follow-up clinical information and discharge info
• Process new admissions: this includes update of patient demographics; create new case in BabyTrax®; document new case in client system; assign Clinical Care Nurse
• Communicate verbally and/or written prior authorizations based on client specifications
• Receive incoming calls for UM and refer to appropriate staff member
• Adheres to policies, procedures and regulations to ensure compliance and patient safety.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
• Provides additional support and project work within the various Care Management areas of accountability as needed.

Qualifications

• 1 – 3 years of experience in customer service in a healthcare environment.
• HS diploma or equivalent required. College degree preferred.
• Insurance/payor experience preferred.
• Working knowledge of healthcare terminology.
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas as well as interact professionally and effectively with members, clients, and staff from all departments within and outside the company.
• Problem solving skills with the ability to look for root causes and implementable, workable solutions.
• Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word.
• Must be fluent in English. Proficiency in a second language is highly desirable.
• Must be self-motivated and willing to learn multiple tasks.
• Must be well-organized and able to prioritize tasks.
• Must have commitment to excellence in customer service.

Benefits/Culture

Some of the benefits we offer our team are:

• Paid Time Off
• Paid Parental Leave
• Medical, dental, vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities

ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com