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. , Review authorization requests for initial determination and triage for clinical review and resolution. , Provide general support and coordination services for the department, including answering and responding to telephone calls, taking messages, and assisting in problem-solving. , 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. , 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. , Knowledge of CPT and ICD-10 coding. , Previous experience working with Medicare/Medicaid enrollees and benefits. Benefits Comprehensive benefits package , Various incentive programs/plans , 401k contribution programs/plans Apply Job!