Care Management UR Coodinator

Join to apply for the Care Management UR Coordinator role at BRMS

Summary: The Utilization Review Coordinator supports the Care Management Department by facilitating the intake, review, and coordination of authorization requests. This position ensures timely and accurate processing of both prospective and retrospective utilization review activities in accordance with company policies, benefit plans, and medical necessity guidelines.

• This is an on-site position.
• Must be able to work 8:30 am to 5 pm, Monday through Friday.
• Maintain strict confidentiality and compliance with HIPAA and internal privacy policies.
• Accurately receive, review, and route incoming authorization requests to the appropriate reviewer.
• Enter and update all utilization review data in the medical management system with accuracy and completeness.
• Review submitted medical documentation for consistency between diagnosis, services requested, and clinical information.
• Verify member eligibility and benefits to support determination of coverage.
• Apply established medical criteria and internal guidelines to assist in the review process.
• Prepare documentation and recommendations for licensed clinical staff and medical directors as part of the determination process.
• Communicate effectively with providers, members, clients, and internal departments regarding authorization requests, status updates, and required information.
• Respond to inbound calls from providers and members in the department’s phone queue, offering professional and accurate assistance.
• Provide backup administrative support as needed, including phones, correspondence, and data entry.
• Perform other duties as assigned by management.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

• Strong verbal and written communication skills.
• Excellent customer service and interpersonal skills for working with internal teams and external clients.
• High level of organization and attention to detail; ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office applications (Word, Excel, Outlook) and Windows-based systems.
• Ability to learn and use medical management and authorization tracking systems.
• Working knowledge of medical terminology, ICD-10, HCPCS, and CPT coding.
• Understanding of evidence-based medical guidelines preferred.
• Knowledge of Durable Medical Equipment (DME) authorization processes preferred.
• Ability to work independently while contributing effectively to a team environment.
• Ability to maintain professionalism in a fast‑paced environment.

• High school diploma or GED required.
• This is an on-site position.
• Must be able to work 8:30 am to 5 pm, Monday through Friday.
• Associate’s degree or higher in a health-related field preferred.
• A minimum of two (2) years of experience in medical administration, utilization review, or health insurance operations is required, with experience in a TPA or managed care setting preferred.
• Equivalent combinations of education and experience will be considered.

• Ability to read, write, and communicate effectively in English.
• Ability to interpret and apply company policies, procedures, and benefit plan documents.
• Ability to compose clear correspondence and communicate effectively with providers, clients, and internal staff.

• Basic mathematical ability to add, subtract, multiply, and divide as needed for data and reporting accuracy.

• Ability to apply sound judgment to follow written, verbal, or diagrammed instructions.
• Ability to identify and resolve issues within standard procedures and guidelines.

• None required.
• Certification in medical billing, coding, or health administration…