General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Plan Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs.

The Utilization Management Intake Coordinator is responsible for the acceptance, processing, and coordination of all referrals for patient care services. Determines eligibility and benefits for new referrals or readmissions or requests for ongoing care while constructing authorizations based on request for services received. Coordinates with facility contacts, utilization management nursing staff and client service specialists to initiate patient care services.

Key Tasks and Responsibilities:

• Initiates the intake process gathering relevant data from the referral source required for authorization request received via, fax or email correspondence, or notification of request for services.
• Notifies departments of new referrals and coordinates information among referral sources, or clinician staff. Provide appropriate documentation to clinical departments for initiation of services.
• Provides clerical, data entry and/or telephone support for the Utilization Management team.
• Manages the workflow for responses to incoming authorization requests and correspondence from Longevity Health Plan members and providers, collaborating with team members to provide timely replies.
• Generates, processes, tracks and stores authorization requests and correspondence related to Care Access and Monitoring.
• Enters member demographic data and provider information updates into appropriate systems.
• Processes and monitors all denial letters through denial database.
• Maintain electronic files of insurance documentation related to all clients and authorization requests.
• Ensure intake paperwork and communication are provided to staff within timeframes allotted by Longevity Health Plan.
• Collaborate with care coordinators to verify automated inpatient and observation admission populated via email on Smartsheet and build authorizations based on notifications.
• Outreach calls to the hospital and/or facilities to request clinicals for the authorization requests.
• Make designated fax attempts to obtain clinicals for the initial inpatient and observation admissions.
• Manage faxes by reviewing each request coming in and making sure all information needed for nurse to review is provided such as CPT codes, diagnosis codes, clinicals and date of services.
• Send email correspondence to leadership to notify them of the inpatient and observation admissions created.
• Manage an average productivity set by Longevity Health Plan leadership based on production and needs of the business.
• Notice of Approvals delegated when needed by Longevity Health plan leadership.
• Work with clinical staff and utilization review specialists to gather information for authorization for benefits, ensuring appropriate documentation is complete.
• Support the generation of letters and communication regarding authorization denials.
• Support the Appeals process from an administrative standpoint as assigned by supervisor.
• Provide exceptional customer service through inbound/outbound calls in our fast‐paced, contact center environment.
• Partner with internal clinical professionals in providing member guidance.
• Verify Member eligibility.
• Is able to adjust shift/scheduling based on the needs of the organization (including occasional paid overtime, shift differential, and working holidays).
• May or will work evening or overnight shifts on a rotating schedule.

Knowledge and Experience:

• Experience with Microsoft Outlook, Office, and Teams.
• Smartsheet preferred but not required.
• Must have strong organizational skills.
• Must have a detail orientation and the proven ability to prioritize work.
• Must have effective verbal and written communication skills.
• Must have the ability to work with limited supervision and as part of a team.
• Sound decision‐making abilities.