Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Care Specialist, Utilization Management
Summary of Position
• Responsible for the execution of the non-clinical aspects of the Utilization Management process.
• Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations,
request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case.
• Work seamlessly with other interdisciplinary teams to ensure members’ needs are met.
• Provide confidential administrative support and assistance to the department in all aspects of daily pro gram operations.
Principal Accountabilities
• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
• Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.
• Triage cases and assign receipts to appropriate teams.
• Respond to inquiries from providers, facilities and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards.
• Provide phone management for both incoming and outgoing calls.
• Communicate with members and providers as required.
• Perform other related projects and duties as assigned.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary.
Education, Training, Licenses, Certifications
• High School Diploma required
• Associates degree or Bachelor’s degree in related field preferred
Relevant Work Experience, Knowledge, Skills, and Abilities
• At least 1-2 years of previous client-facing or data entry experience in a health care environment.
• Additional years of experience/certifications/training may be considered in lieu of educational requirements.
• Strong communication skills (verbal, written and interpersonal).
• Ability to work both independently and collaboratively with others.
• Previous system user experience in a highly electronic environment.
• Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.).
• Knowledge of medical terminology and medical payment.
• Ability to prioritize multiple tasks.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.