HMO Coordinator(Full Time)

Position Overview:

We are seeking a dedicated and detail-oriented HMO Coordinator to join our Quality Assurance-Utilization Review (QA-UR) Department. The HMO Coordinator will be responsible for managing and coordinating health maintenance organization (HMO) activities, ensuring compliance with regulatory requirements, and supporting quality assurance and utilization review processes. This role requires excellent organizational skills, a thorough understanding of healthcare policies, and the ability to work collaboratively with various stakeholders.

Key Responsibilities:

• Coordinate and manage HMO-related activities, including authorizations, referrals, and patient care plans.
• Collaborate with healthcare providers, insurance companies, and patients to ensure timely and accurate processing of HMO claims and requests.
• Review and analyze utilization data to identify trends, issues, and opportunities for improvement in patient care and resource use.
• Ensure compliance with HMO regulations, standards, and contractual obligations.
• Prepare and maintain documentation related to HMO activities, including reports, records, and correspondence.
• Assist in the development and implementation of policies and procedures related to HMO coordination and utilization review.
• Support the QA-UR team by providing data and insights related to HMO performance and outcomes.
• Address and resolve any issues or discrepancies related to HMO processes and patient care.
• Stay updated on changes in HMO regulations and industry best practices to ensure ongoing compliance and quality improvement.
• Facilitate communication and coordination between HMO representatives, healthcare providers, and internal departments.

Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred; relevant work experience may substitute for education.
• Minimum of 2-3 years of experience in a healthcare coordination role, preferably involving HMO or insurance-related tasks.
• Strong understanding of HMO processes, healthcare regulations, and utilization review principles.
• Excellent organizational and multitasking skills with a keen attention to detail.
• Proficiency in using healthcare management software and electronic health record (EHR) systems.
• Strong analytical skills with the ability to interpret data and generate reports.
• Effective communication and interpersonal skills, with the ability to collaborate with various stakeholders.
• Ability to handle sensitive information with confidentiality and professionalism.