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
• Perform member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation.
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• Review authorization requests for initial determination and triage for clinical review and resolution.
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• Provide general support and coordination services for the department, including answering and responding to telephone calls, taking messages, and assisting in problem-solving.
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• 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
• High School Diploma or GED.
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• 3 years of experience in health care claims/service areas or office support.

Nice-to-haves
• Two years' experience in a health care/managed care setting or previous work experience within the division.
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• Knowledge of CPT and ICD-10 coding.
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• Previous experience working with Medicare/Medicaid enrollees and benefits.

Benefits
• Comprehensive benefits package
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• Various incentive programs/plans
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• 401k contribution programs/plans

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