Remote UR Intake Coordinator presso UNITE HERE HEALTH

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

This is a Culinary Health Fund Position

Our Medical Management department is participant focused and strives to provide the best possible care for the participants through Utilization Review and Utilization Management services, Care Coordination and Outreach. The Department is designed to ensure the delivery of high-quality, cost-efficient healthcare for our participants and families through coordinating care, providing detailed discharge plans, advising participants of different programs available and providing telephonic education. 

The Intake Coordinator performs a variety of duties with the majority being clerical and customer service in nature.  The position of the Intake Coordinator is to facilitate utilization review by performing data collection, completing data entry and effectively communicating with the Utilization Review team regarding individual participants. 

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Adhere to established URAC standards and all Nevada Health Solutions LLC’s policies and procedures
• Contributes to UM program goals and objectives in containing health care costs and maintaining a high-quality medical delivery system through the program procedures for conducting UM activities
• Must become knowledgeable of URAC requirements for clinical staff for UM accreditation
• Collect data upon notification from patient/patient representative, physician, or hospital
• Interact telephonically with participants, hospital staff, physician staff, and physicians to determine medical status, type of care requested (surgery, hospitalization and/or physical therapy
• Maintain accurate records of individual cases
• Inform callers that the Nurse Case Manager will review the medical information for review and certification, if information is available the caller will be transferred to Nurse
• Collects only pertinent clinical information and documents all UM review information using the appropriate software system
• Follows relevant time frame standards for conducting and communicating UM review determination
• Maintains and submits reports and logs on review activities as outlined by the UM program operational procedures
• Maintains a courteous, professional attitude when working with the Client’s staff, hospital and physician providers, and all ancillary providers
• Exemplifies the Fund’s values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement

ESSENTIAL QUALIFICATIONS

• 2+ years of experience in customer service
• Fluent in Spanish language
• Experience as an intake specialist with a healthcare or utilization management company, preferred
• Working knowledge of utilization management preferred 

Salary range for this position: Hourly $27.74 - $33.95. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. 

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a remote employee with a 8-4pm PST shift.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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