Medical Management Care Coordinator, Utilization Management

Company: VNS Health
Location: New York
Posted on: May 24, 2025

Job Description:

OverviewCollects specific data in the medical management information system for the clinical staff. Resolves authorization issues as well as troubleshoots, researches, and resolves related issues in a timely and efficient manner. Works under general supervision.Job DescriptionWhat We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, including Medical, Dental, Vision, Life, and Disability
• Employer-matched retirement savings funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, CEU credits, and advancement opportunities
• Interdisciplinary network of colleagues through the VNS Health Social Services Community of ProfessionalsWhat You Will Do
  • Obtain information from doctors and/or providers and enter data into the medical management information system to enable clinical staff to correctly apply assessment tools.
  • Create case files for services that require authorization and maintain accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication.
  • Deliver strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved.
  • Track and monitor customer complaints concerning service requests. Report any unusual or complex issues/trends to management; recommend corrective actions.
  • Provide triage and management of calls ensuring that established call performance targets are consistently achieved.
  • Provide feedback to leadership regarding training needs.
  • Collaborate with management to determine the best approach to serve customers, handle repeat vendor issues, and other job-related matters to maximize and improve delivery, billing, and payment of goods and services.
  • Protect the confidentiality of member information and adhere to company policies regarding confidentiality.
  • Participate in special projects and perform other duties as assigned.QualificationsEducation: High School Diploma or equivalent RequiredWork Experience:
    • Minimum of two years of experience in a customer service role Required
    • Excellent oral and written communication skills Required
    • Advanced personal computer skills, including Word, Excel, or Access Required
    • Utilization Management experience PreferredPay RangeUSD $20.98 - USD $26.23 /Hr.About UsVNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age, and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise, and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions, and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
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Keywords: VNS Health, West Hartford , Medical Management Care Coordinator, Utilization Management, Healthcare , New York, Connecticut