REMOTE Utilization Management Associate

Job Description

Job Description

Utilization Management Associate - Managed Care / Appeals (Remote - Tri-State Area)

We are seeking a detail-oriented and customer-focused Utilization Management CMA to support authorization processing, member/provider communication, and appeals coordination within a fast-paced healthcare environment. This is a fully remote opportunity; however, candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut).

Schedule

Monday - Friday | 9:00 AM - 5:00 PM

Position Overview

The UM CMA will support Utilization Management operations by processing authorization requests, coordinating with providers and members, documenting case activity, and ensuring timely and accurate handling of UM and appeal-related functions. This role requires strong administrative skills, healthcare knowledge, and the ability to work independently in a high-volume environment.

Key Responsibilities

• Receive and process UM service requests from providers and members through fax, provider portals, call center systems, and other intake channels
• Handle inbound calls from providers and members while addressing questions related to benefits, policies, procedures, and authorization status
• Strive to achieve first-call resolution and provide exceptional customer service
• Verify member eligibility and benefits using internal systems and resource tools
• Create and complete authorization requests and generate reference numbers
• Follow established UM workflows to process requests or escalate to clinical staff when appropriate
• Request and review supporting clinical documentation necessary to determine medical necessity
• Process inbound correspondence and ensure accurate association with member records
• Generate approval and denial letters using system correspondence templates
• Accurately document member, provider, and clinical information within internal systems
• Support UM appeals by managing authorization updates, outreach efforts, determination notifications, and tracking related activities
• Participate in departmental projects, audits, regulatory clean-up initiatives, and quality improvement activities
• Attend ongoing trainings and staff meetings to enhance knowledge and performance
• Assist team members and perform additional duties as assigned

Qualifications

Required

• High School Diploma or GED
• 1-3 years of administrative support experience within Utilization Management or Appeals
• Strong computer and data entry skills
• Ability to work efficiently in a high-volume environment
• Excellent communication and customer service skills

Preferred

• Understanding of medical terminology including ICD-10, HCPCS, and CPT-4 coding
• Call center or healthcare customer service experience
• Self-starter with the ability to work independently
• Strong organizational and multitasking skills

Ideal Candidate

The ideal candidate is dependable, detail-oriented, and comfortable working in a fast-paced managed care environment. They should be able to work independently while maintaining accuracy, professionalism, and a high level of member and provider support.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?