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One Mission. More Than Half a Million Reasons.
As we empower every New Yorker
to live the healthiest life possible.

BH UM Care Coordinator

Job Ref: 107661
Category: Utilization Review and Case Management
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $55,000.00
Salary Range: $55,000.00 - $56,650.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

The Behavioral Health Utilization Management Care Coordinator provides comprehensive service and support to providers and members as needed. The primary responsibilities include but are not limited to: responding to all provider inquiries for Behavioral Health Core and HARP authorizations, documenting such contacts into the tracking clinical system, manage and maintain inbound queues for the UM work system, process complaints, conduct outreach efforts to providers and ensure all activities deliver a seamless and streamlined experience for both UM staff and providers. This position requires that one be organized, ability to multitask, set priorities and manage time effectively.

Job Description

  • Responsible to manage large amounts of inbound provider calls promptly.
  • Record and respond to all BH UM Customer contacts and update the tracking system.
  • Manage and ensure appropriate follow-up and closure for all provider/member contacts.
  • Manages calls to and from providers regarding both inpatient and outpatient BH authorizations
  • Enter prior approvals in the authorization System (CareConnect) and follow internal process for connecting providers to the Clinical UM Staff as applicable.
  • Notifies vendors of the start date of the services to member
  • Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests
  • Tracks and monitors key information identified by the UM Team Leaders for quality purposes
  • Maintain clinical work queues to ensure tasks are sent timely to UM team members
  • Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM customer service associate level and collaborate with other BH UM team members to ensure that the entire team is also successful at meeting those standards.
  • Process and resolve complaints, record given information in the clinical management system
  • Handle provider inquiries and escalates to Call Center Supervisor appropriately
  • Respond to all claim billing inquiries from providers and members and direct them to the correct teams.
  • Cross Cover the Member ACD line along with any workflows or use of documentation tools used in Case Management.
  • All other duties and special projects as assigned by BH UM Care Coordinator Supervisor and Director of BH UM Director

Minimum Qualifications

  • Associates Degree required; Bachelor’s Degree preferred
  • A minimum of 3 years' experience in customer service; 1 year must be in a UM medical management call center setting
  • Experience in providing excellent customer service in a fast-paced, high volume type medical setting (i.e., insurance, doctor’s office, medical clinics)
  • Bilingual (English/Spanish) - written and verbal skills preferred
  • Basic Microsoft Word, Teams and Excel skills; familiarity with Microsoft Teams is a plus
  • UM clinical operations expertise a bonus

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication
  • Ability to multitask and work as a team
  • Must be able to work well under pressure and handle stressful situations effectively
  • Ability to maintain a positive and customer friendly attitude while fielding calls