תיאור התפקיד
Convergence Workforce is a full-service, hassle-free solution for healthcare and related operational needs. We provide high-quality, cost-effective, and customized, data-driven solutions
Our company culture is founded on building our employees up, giving them the support to grow in an exciting and driven workplace environment. When you love what you do and you love where you work, it’s hard not to thrive! Our management team is known for being exceptionally communicable, actively seeking input and out-of-the-box creative thinking. Convergence is looking for a Utilization Review Director
In this role, you will be managing a small but rapidly growing team of care coordinators who assist our internal customers (employees) with navigating their insurance benefits and assisting them with a variety of things such as finding participating providers and facilities, escalating issues, expediting prior authorizations, and educating members on access to care and claims. We are seeking an individual with strong advocacy skills who can lead a team to guide members with compassion and empathy. You and your team will also act as the liaison between the members and a third-party benefits administrator. This role is remote
דרישות התפקיד
Oversees service requests, authorizations and service metrics
Reviews documentation quality for clinical effectiveness in regards to reimbursement
Participates in clinical team for goal alignment and compliance
Develops processes to minimize denials and provides education
Possesses strong knowledge of external review organizations
Facilitates UM team meetings
Full-time hours, with flexibility for some evening hours
