Utilization Management Coordinator - Remote / Telecommute

Job Title

Responsible for providing administrative and coordination support within utilization management processes, including benefit verification, authorization management, and claims-related inquiries.

The role involves reviewing authorization requests, supporting clinical triage processes, maintaining documentation, and assisting with reporting and data tracking in a healthcare managed care environment.

Requirement/Must Have:

• Strong communication, organizational, and customer service skills.
• Ability to work effectively in a multi-disciplinary team environment.
• Strong attention to detail and accuracy.
• Ability to follow standardized processes and procedures.
• Strong independent judgment and decision-making skills.
• Knowledge of basic medical terminology and managed care concepts.
• Experience using Microsoft Office applications (Word, Excel, PowerPoint).
• Ability to work with web-based systems and tools.
• Strong documentation and coordination skills.

Experience:

• Minimum 3 years of experience in healthcare claims, healthcare service support, or office support roles.
• Experience in managed care or healthcare environment preferred.
• Experience handling authorization or utilization management processes preferred.
• Familiarity with CPT and ICD-10 coding preferred.

Responsibilities:

• Provide administrative support for members and providers including benefit verification, authorization creation, claims inquiries, and case documentation.
• Review authorization requests for initial determination and route for clinical review when required.
• Triage authorization requests and support resolution processes.
• Handle inbound calls, correspondence, and general departmental support tasks.
• Research information and assist in resolving operational and service issues.
• Support reporting, data tracking, and information organization activities.
• Assist with Continuity of Care processes and Peer-to-Peer review tracking.
• Maintain accurate documentation and ensure timely processing of requests.