Lead Care Coordinator

Responsibilities

• Lead daily operations and workflow of the UM Coordinator team to ensure timely processing of authorization requests
• Serve as the primary resource and subject matter expert for UM Coordinators, providing guidance and coaching
• Assist leadership with onboarding, training, and mentoring new and existing UM Coordinators
• Monitor team productivity, work queues, and turnaround times to ensure regulatory compliance
• Receive, review, and process incoming requests for authorization of medical services
• Coordinate with providers, members, and internal clinical staff to obtain required documentation
• Enter authorization requests and determinations into the utilization management system accurately
• Communicate authorization determinations to providers and members within required regulatory timeframes
• Perform quality reviews of authorization documentation and identify process improvement opportunities
• Promote compliance with NCQA, CMS, state and federal regulations, and HIPAA standards

Requirements

• High School Diploma or equivalent required
• 3–5 years of experience in a health plan or managed care environment
• 2 years of Utilization Management, Prior Authorization, or Case Management support experience
• Bilingual (English/Spanish) required
• Proficiency with Microsoft Office Suite and utilization management platforms (e.g., MCG, InterQual)
• Advanced knowledge of medical terminology and healthcare benefit processes

Preferred Qualifications

• Associate's degree in Healthcare Administration or a related field
• Previous experience as a team lead, trainer, or mentor
• Medical Assistant certification or other healthcare certification

About the Company

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.