Utilization Management Coordinator

Job Summary

A company is looking for a Utilization Management Coordinator.

Key Responsibilities

• Assist the clinical team with administrative tasks related to Utilization Management prior authorizations and appeals
• Verify eligibility, process incoming faxes, and ensure documentation completeness for authorization requests
• Initiate appeal cases and maintain communication with providers and members for necessary documentation

Required Qualifications

• High school diploma required
• At least 1 year of experience in a UM Coordinator or similar administrative role within a health plan or managed care organization
• Familiarity with UM processes, ICD-10, and HCPCS codes
• Proficient computer skills, including Microsoft Word and healthcare software navigation
• Experience with DMEPOS authorization workflows and familiarity with Medicare and/or Medicaid UM processes preferred