Coordinator, UM Operations

This position is an onsite role working out of our Appleton office located at 1025 West Navitus Drive, Appleton, WI 54913.

Navitus Health Solutions is seeking a UM Operations Coordinator to join our Prior Authorization department!

The Coordinator, Utilization Management (UM) Operations role is to support the operational work of the Utilization Management Program. Job duties will include reporting and administrative functions. Specifically, the Coordinator will ensure timely and accurate fulfillment of Prior Authorization Member and Prescriber notifications. The Coordinator will troubleshoot communications that have failed and ensure the communications are processed timely and accurately. This role requires a high attention to detail within short turnaround times. The coordinator will develop and maintain a working knowledge of Prior Authorization systems and workflows. The ability to work collaboratively with others, problem solve and troubleshoot, focus and prioritize work, and understand specific client or regulatory variations is critical.

Is this you? Find out more below!

How do I make an impact on my team?

Assume responsibility for letter fulfillment, monitoring automated fulfillment equipment. Working with Navitus' vendors to ensure uptime and proper inventory
• Troubleshoot failed member and prescriber fulfillment (automated and manual)
• Develop and maintain expert knowledge of Medicare D, Medicaid, and/or Exchange programs
• Properly prioritize prior authorization work queues to ensure requests meet internal and client expectations
• Adhere to governmental regulations and processes while executing mailing and faxing tasks
• Execute on project work associated with the various prior authorization products from inception through completion
• Assist with prior authorization reporting needs as assigned
• Develop, document, and maintain policies, procedures and associated training plans as needed
• Other duties as assigned

What our team expects from you?

• High school diploma required. Associate degree or equivalent preferred
• Experience with a combination of the following: previous administrative work, customer service experience, expertise working across multiple departments, technical and business acumen, and a track record of tangible success
• Experience in health insurance/pharmacy insurance or managed care organization preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What you can expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Program and Professional Membership assistance
• Referral Bonus Program - up to $750!

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