[Remote/WFM] Remote Coordinator for Utilization Management
Key Job Details:Start Date: Immediate openings availablePosition: Remote CoordinatorLocation: RemoteCompensation: a competitive salaryCompany: Utilization Management  Job Title: Utilization Management Coordinator - Remote
Job Overview
As a vital member of our clinical team, the Utilization Management (UM) Coordinator will provide essential support in handling administrative and non-clinical tasks related to the processing of UM prior authorizations and appeals. This position is designed for those who thrive in a dynamic and fast-paced environment, offering significant opportunities for professional growth while contributing to our mission of enhancing the quality of life for the communities we serve.
Key Responsibilities
 Monitor and manage incoming faxes
 Input UM authorization review requests into our proprietary UM platform using ICD-10 and HCPCS codes
 Verify eligibility and claims history within our claims system
 Ensure comprehensive documentation accompanies all authorization requests
 Communicate with requesting providers to gather necessary medical records or documentation
 Prepare and disseminate correspondence, including member and provider notifications
 Execute verbal notifications and maintain documentation in the authorization platform
 Initiate appeal processes and collaborate with UM Nurses for completion
 Adhere to internal and regulatory deadlines for UM processes
 Handle inquiries from the call center and other internal and external sources
 Perform additional tasks as assigned by the UM Director
Required Skills
 Exceptional organizational skills with the ability to adapt to rapid changes
 Team-oriented mindset with a self-motivated and positive attitude
 Proficient knowledge of ICD-10, HCPCS codes, and medical terminology
 Strong computer skills, particularly in Word, Outlook, and relevant software applications
 Effective written and verbal communication abilities
 Capability to collect data, establish facts, and derive valid conclusions
 Experience with DMEPOS is desirable
 Familiarity with Medicare and Medicaid is advantageous
Qualifications
 Minimum of 1 year of experience in a UM Coordinator role within a managed care payer environment is preferred
 Proven ability to prioritize and manage multiple tasks efficiently
Career Growth Opportunities
In your first six months, you will gain proficiency in verbal notifications, authorization systems such as Essette and Salesforce, and develop a thorough understanding of UM team expectations. Over the first year, you will deepen your knowledge of ICD-10 and HCPCS codes while meeting essential timelines.
Company Culture And Values
Established in 2005, our organization is a prominent network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We aim to transform access to in-home healthcare, positively impacting the communities we serve. Our culture emphasizes collaboration and teamwork, guided by our core values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We seek motivated and dedicated individuals eager to join our mission-driven team.
Compensation And Benefits
 Competitive hourly wage of $19
 Comprehensive benefits package including Medical, Dental, Vision, Life Insurance, and Paid Time Off (PTO)
 Retirement plan with company match
 Paid Parental Leave and Sick Time
 Company-sponsored events and health and wellness programs
 Remote work flexibility available for eligible candidates.
Employment Type: Full-Time Apply Job! Join Our Team!This is a fantastic opportunity to grow your career. If you have the skills and passion we're looking for, please submit your application today.
Apply Now
Job Overview
As a vital member of our clinical team, the Utilization Management (UM) Coordinator will provide essential support in handling administrative and non-clinical tasks related to the processing of UM prior authorizations and appeals. This position is designed for those who thrive in a dynamic and fast-paced environment, offering significant opportunities for professional growth while contributing to our mission of enhancing the quality of life for the communities we serve.
Key Responsibilities
 Monitor and manage incoming faxes
 Input UM authorization review requests into our proprietary UM platform using ICD-10 and HCPCS codes
 Verify eligibility and claims history within our claims system
 Ensure comprehensive documentation accompanies all authorization requests
 Communicate with requesting providers to gather necessary medical records or documentation
 Prepare and disseminate correspondence, including member and provider notifications
 Execute verbal notifications and maintain documentation in the authorization platform
 Initiate appeal processes and collaborate with UM Nurses for completion
 Adhere to internal and regulatory deadlines for UM processes
 Handle inquiries from the call center and other internal and external sources
 Perform additional tasks as assigned by the UM Director
Required Skills
 Exceptional organizational skills with the ability to adapt to rapid changes
 Team-oriented mindset with a self-motivated and positive attitude
 Proficient knowledge of ICD-10, HCPCS codes, and medical terminology
 Strong computer skills, particularly in Word, Outlook, and relevant software applications
 Effective written and verbal communication abilities
 Capability to collect data, establish facts, and derive valid conclusions
 Experience with DMEPOS is desirable
 Familiarity with Medicare and Medicaid is advantageous
Qualifications
 Minimum of 1 year of experience in a UM Coordinator role within a managed care payer environment is preferred
 Proven ability to prioritize and manage multiple tasks efficiently
Career Growth Opportunities
In your first six months, you will gain proficiency in verbal notifications, authorization systems such as Essette and Salesforce, and develop a thorough understanding of UM team expectations. Over the first year, you will deepen your knowledge of ICD-10 and HCPCS codes while meeting essential timelines.
Company Culture And Values
Established in 2005, our organization is a prominent network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We aim to transform access to in-home healthcare, positively impacting the communities we serve. Our culture emphasizes collaboration and teamwork, guided by our core values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We seek motivated and dedicated individuals eager to join our mission-driven team.
Compensation And Benefits
 Competitive hourly wage of $19
 Comprehensive benefits package including Medical, Dental, Vision, Life Insurance, and Paid Time Off (PTO)
 Retirement plan with company match
 Paid Parental Leave and Sick Time
 Company-sponsored events and health and wellness programs
 Remote work flexibility available for eligible candidates.
Employment Type: Full-Time Apply Job! Join Our Team!This is a fantastic opportunity to grow your career. If you have the skills and passion we're looking for, please submit your application today.
Apply Now