Utilization Management Coordinator

Seeking a Healthcare focused, Utilization Management Coordinator, to support the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care.

ESSENTIAL FUNCTIONS:
- 35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
- 35% Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
- 20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
- 10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

- Education Level: High School Diploma required
- 2+ years of Utilization Management Coordination; working with medical authorizations and inputting authorizations into systems. Background in reviewing clinical information and requests request for authorization/request for continued to stay in hospital, etc..
- CPT and ICD-10 coding, Medical Coding = Required
- Facets = Required
- GuidingCare = Required
- Millennium Care Guidelines (MCG) = required
- Must have strong Data Entry and Customer Service abilities
- Strong Data Entry skills and data analysis skills for proper code matching.
- Strong MS Suite experience (Outlook, Word, Excel)