Utilization Management Coordinator - Remote​/Telecommute

Pay Range: $20.66hr - $24.66hr

The Utilization Management Coordinator provides administrative and operational support for utilization management activities. This role involves reviewing authorization requests, supporting members and providers, coordinating departmental processes, and assisting with reporting and data tracking. The ideal candidate will have healthcare administrative experience and strong attention to detail.

• Perform administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation.
• Assist members and providers with inquiries related to services and benefits.
• Ensure accurate documentation and tracking of cases.

• Review authorization requests for initial determination.
• Triage cases for clinical review and resolution as appropriate.
• Maintain timely and accurate processing of authorization requests.

• Answer and respond to telephone calls and correspondence.
• Take messages and provide follow-up communication as needed.
• Research information and assist in resolving issues.
• Support coordination activities within the department.

• Assist with reporting, data gathering, tracking, organization, and dissemination of information.
• Support Continuity of Care processes and tracking of Peer-to-Peer reviews.
• Maintain accurate records and support quality improvement initiatives.

• High School Diploma.
• Three years of experience in healthcare claims, service areas, or office support roles.
• Ability to perform essential duties with accuracy and efficiency.

• Two years of experience in a healthcare or managed care setting.
• Previous work experience within the division.
• Knowledge of CPT and ICD-10 coding.

• Ability to effectively participate in a multidisciplinary team with internal and external stakeholders.
• Excellent communication, organizational, and customer service skills.
• Knowledge of basic medical terminology used in managed care.
• Understanding of standardized processes for evaluating medical support operations.
• Strong independent judgment and decision-making skills with tact and diplomacy.
• Strong attention to detail.
• Proficiency in web-based technologies and Microsoft Office applications including Word, Excel, and PowerPoint.