Utilization Management Coordinator

Employer Industry: Healthcare Services

• Salary up to $22.50 per hour
• 5% annual incentive target based on performance goals
• Comprehensive benefits including medical, dental, vision, and 401(k) with employer match
• Generous time off policies including 17 days of PTO and 10 standard holidays
• Opportunity to work in a supportive environment focused on community health
• Chance to contribute to the wellbeing of members and improve healthcare access

• Process data entry for referrals, prior authorizations, and hospital notifications
• Determine appropriate medical coding using CMS, NCQA, and HCA criteria
• Validate benefit and prior authorization requirements within the Care Management system
• Review and approve authorization requests, referring complex cases to clinical staff
• Ensure accuracy and compliance of denial letters and maintain timely communication

• Associate degree or equivalent combination of education and relevant experience
• Minimum of one (1) year of customer service experience
• Experience in a healthcare or managed care setting
• Knowledge of medical terminology and healthcare processes
• Ability to work independently and maintain confidentiality

• Familiarity with Washington Apple Health and Medicare Advantage Plans
• Strong analytical skills with the ability to interpret and evaluate data
• Proficiency in Microsoft Office products
• Experience in care management workflow systems
• Effective verbal and written communication skills with healthcare providers

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