Utilization Management Coordinator
Remote - Orlando, Florida, United States
Olive’s AI workforce is built to fix our broken healthcare system by addressing healthcare’s most burdensome issues -- delivering hospitals and health systems increased revenue, reduced costs, and increased capacity. People feel lost in the system today and healthcare employees are essentially working in the dark due to outdated technology that creates a lack of shared knowledge and siloed data. Olive is designed to drive connections, shining a new light on the broken healthcare processes that stand between providers and patient care. She uses AI to reveal life-changing insights that make healthcare more efficient, affordable and effective. Olive’s vision is to unleash a trillion dollars of hidden potential within healthcare by connecting its disconnected systems. Olive is improving healthcare operations today, so everyone can benefit from a healthier industry tomorrow.
Olive Shares is connecting providers and payers to create the Internet of Healthcare. Our team builds and implements a suite of Software as a Service (SaaS) products that integrate across Electronic Health Record systems and payer systems, with intuitive workflows and deep healthcare expertise. Our SaaS platform accelerates prior authorizations for providers, and enables the first-in-the-world real-time AI clinical reviews.
As the Utilization Management Coordinator, you will be a key member of the Olive Shares team and help ensure success of our products. You’ll work closely with our internal teams to map prior authorization workflows across the payer setting. You have exceptional communication skills with the ability to synthesize complex information into simple, coherent terms.
Essential Duties and Responsibilities:
- You are someone who enjoys sharing your knowledge, as you partner with your team, and cross-functionally, to communicate your expertise in utilization management processes.
- You are a logical thinker, and can take complex directions and distill them into clear step-by-step instructions.
- You can create clear workflow maps to illustrate prior authorization and utilization management processes.
- You are able to take complicated information and make it simple and easy to understand.
- You are naturally a problem-solver and develop intuitive solutions through collaboration and communication.
- Research and understand utilization management workflows and potential methods of handling data and complex edge cases.
- 3+ years experience within utilization management from health plans/payers. We are looking for candidates with clinical backgrounds as well as candidates with non-clinical/administrative backgrounds.
- Responsible for managing inbound authorization requests, with a deep understanding of the workflow/lifetime of the prior authorization request.
- Preferable experience in creating prior authorization requests in diagnostic radiology, orthopedic surgery setting.
- Understands how requirements are applied to Approve/Deny/P2P.
- Commercial experience and Medicare/Medicaid including understanding of NCD/LCD.
- Understanding of reporting and productivity numbers which are important for payer staff.
- Ability to take on meaningful responsibility, individual initiative and thrive with limited supervision.
- Comfortable with ambiguity and able to design organized approaches to address.
At Olive, we're committed to growing and empowering an inclusive community within our company and industry. This is why we hire and cultivate diverse teams of the best and brightest from all backgrounds, experiences, and perspectives across our organization. Research shows that oftentimes women and other minority groups only apply to open roles if they meet 100% of the listed criteria. Olive encourages everyone — including women, people of color, individuals with disabilities and those in the LGBTQIA+ community — to apply for our available positions, even if they don't necessarily check every box on the job description.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned.
This job description does not constitute a contract of employment and Olive AI, Inc. may exercise its employment-at-will rights at any time.
We take the health and happiness of our employees seriously and consistently evaluate new ways to provide an amazing place to work. From retirement planning, to a wellness program designed to actively incorporate mental and physical wellness into daily interactions amongst fellow Olivians, we make sure to take care of our own.
- Health, Dental, and Vision insurance that starts on your first day at Olive with 100% of premiums covered for team members and 75% covered for dependents
- Monthly Grid stipend to cover work related expenses
- Unlimited PTO
- EAP/Mental health resources
- Getaways by Marriott Bonvoy
- Family-building and fertility support via Kindbody
- 12 weeks of parental leave
- 401(K) match
- Wellness program
- Stock Options
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