Utilization Mangement Coordinator, (Remote)
About the position
The Utilization Management Coordinator supports the clinical teams by handling non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. This remote position focuses on government programs, including Medicare Advantage and Maryland Medicaid, and requires occasional in-person attendance at CareFirst locations for meetings and training.
Responsibilities
Ā Perform member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation.
,
Ā Review authorization requests for initial determination and triage for clinical review and resolution.
,
Ā Provide general support and coordination services for the department, including answering and responding to telephone calls, taking messages, and assisting in problem-solving.
,
Ā Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
Requirements
Ā High School Diploma or GED.
,
Ā 3 years of experience in health care claims/service areas or office support.
Nice-to-haves
Ā Two years' experience in a health care/managed care setting or previous work experience within the division.
,
Ā Knowledge of CPT and ICD-10 coding.
,
Ā Previous experience working with Medicare/Medicaid enrollees and benefits.
Benefits
Ā Comprehensive benefits package
,
Ā Various incentive programs/plans
,
Ā 401k contribution programs/plans
Apply Now
The Utilization Management Coordinator supports the clinical teams by handling non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. This remote position focuses on government programs, including Medicare Advantage and Maryland Medicaid, and requires occasional in-person attendance at CareFirst locations for meetings and training.
Responsibilities
Ā Perform member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation.
,
Ā Review authorization requests for initial determination and triage for clinical review and resolution.
,
Ā Provide general support and coordination services for the department, including answering and responding to telephone calls, taking messages, and assisting in problem-solving.
,
Ā Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
Requirements
Ā High School Diploma or GED.
,
Ā 3 years of experience in health care claims/service areas or office support.
Nice-to-haves
Ā Two years' experience in a health care/managed care setting or previous work experience within the division.
,
Ā Knowledge of CPT and ICD-10 coding.
,
Ā Previous experience working with Medicare/Medicaid enrollees and benefits.
Benefits
Ā Comprehensive benefits package
,
Ā Various incentive programs/plans
,
Ā 401k contribution programs/plans
Apply Now