Utilization Management Coordinator

Utilization Management Coordinator

In this role, you'll support Utilization Management (UM) clinical teams by handling non-clinical administrative work tied to pre-service authorization, utilization review support, care coordination workflows, and quality-of-care processes. You'll help manage authorization intake, documentation, and provider/member supportwhile working in a fast-paced environment where schedule flexibility (including weekends) is required.

• Provide member/provider administrative support such as benefit verification, authorization creation/management, claims inquiries, and case documentation.
• Review incoming authorization requests for initial determination and/or triage items for clinical review and resolution.
• Support day-to-day coordination for the department, including answering/responding to phone calls, taking messages, and responding to basic inquiries.
• Research information and assist with issue resolution and operational problem-solving.
• Assist with reporting, data tracking, and organizing/disseminating information (including Continuity of Care processes and tracking Peer-to-Peer reviews).

High School Diploma (or equivalent)

• 3+ years of experience in healthcare claims/service areas and/or healthcare office/administrative support
• Ability to work effectively within a multidisciplinary team (internal and external partners)
• Strong communication, organization, and customer service skills
• Strong attention to detail with sound judgment and decision-making
• Comfortable with web-based tools and Microsoft Office (Word, Excel, PowerPoint)

Knowledge of CPT and ICD-10 coding / medical terminology used in managed care

• Experience in a managed care environment (health plan / UM support)
• Phone-heavy/customer support experience
• Experience with Medicaid/Medicare (government programs)
• Exposure to tools such as Facets, Guiding Care, and/or NICE CXone

System One, and its subsidiaries including Joul and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.