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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