Progyny is looking for a Utilization Management Compliance Coordinator to support all utilization review cases with an expanded focus on compliance and accreditation standards. The coordinator will review and analyze member cases to determine medical necessity and issue authorizations for treatment.
Requirements
- Bachelor’s degree in nursing preferred
- 1+ year of fertility nursing experience
- Minimum 2 years of experience in compliance or accreditation preparation preferred
- Current licensed professional registered nurse
- Familiarity with URAC/NCQA standards and state-specific UM regulations
- Experience in audit preparation and regulatory reporting
- Knowledge of CPT, HCPCS, ICD-10 codes and understanding of medical terminology
- Strong communication and presentations skills
- Strong attention to detail
- Excellent written and verbal communication skills
- Ability to communicate effectively and thoughtfully with providers and patients regarding authorization requests and determinations
- Ability to work independently with minimal supervision and escalate when necessary
- Strong multi-tasking and prioritization skills
- Experience working with CRM platforms (specifically Salesforce) and reporting / dashboard management
- Experience with CRM platforms / JIRA as it relates to bug reporting
- Experience and facility working with Microsoft Office Suite (Excel, Word, PowerPoint, Outlook)
- Ability and willingness to learn new programs and platforms to optimize UM workflow/Member experience
Benefits
- Paid family and parental leave
- Preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support)
- Family and pet care fund
- Menopause and midlife care
- Health, dental, vision and life insurance options for employees and family
- Free in-person, virtual and text-based mental health and wellness support
- Paid time off, including vacation, sick leave, personal days and summer flex time
- Company equity
- Bonus program
- 401(k) plan with company match
- Access to on-demand legal and financial advice
- Learning and development programs to help you grow professionally and a mentorship program
- Company social events to include annual volunteer day and donation matching
- Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office
