Utilization Management Coordinator - II

General Information

Job Description: PURPOSE:

Supports 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. We are seeking a detail-oriented individual to handle various data entry tasks within our healthcare organization. The role involves efficiently routing and resolving cases, as well as coordinating services, which includes managing incoming calls from providers and messages. Additionally, the candidate will be responsible for reaching out to providers to facilitate case closure. Proficiency in Microsoft Office applications is required, and a minimum of 3 years of experience in healthcare is necessary. Preferred qualifications include knowledge of CPT and ICD-10 coding, as well as experience with Guiding Care Health Age or similar systems. The ideal candidate should possess excellent organizational skills, be adept at problem-solving, and exhibit strong communication abilities.

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.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable

accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma

Experience: 3 years experience in health care claims/service areas or office support.

Preferred Qualifications

Two years’ experience in health care/managed care setting or previous work experience within division

Knowledge of CPT and ICD-10 coding.

Knowledge, Skills and Abilities (KSAs)

Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient

Excellent communication, organizational and customer service skills. , Proficient

Knowledge of basic medical terminology and concepts used in managed care., Proficient

Knowledge of standardized processes and procedures for evaluating medical support operations business practices., Proficient

Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy. , Proficient

Ability to pay attention to the minute details of a project or task, Proficient

Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Job Type: Contract

Pay: $20.00 - $22.00 per hour

Schedule:

• 8 hour shift

Ability to Relocate:

• Owings Mills, MD 21117: Relocate before starting work (Required)

Work Location: Hybrid remote in Owings Mills, MD 21117