Seeking a Utilization Management Coordinator for a 100% Remote position.

The Utilization Management Coordinator functions under the direction of the PSMR Manager, to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to pre-service,
concurrent and post service review functions. Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information, and /or records for prompt review and response. The Utilization Management Coordinator II has more experience and acts a resource for others, is given more complex assignments, precepts new hires and supports work distribution & team monitoring activities as needed.

Essential functions

• Provides world class telephone customer service to plan members and/or providers by answering benefit
  questions, researching and resolving issues and inquiries and ensuring members and providers understand the
  Company’s products and services. Duties Including:
• Determines contract and benefit eligibility
• Initiates and manages clinical referrals for members.
• Verifies insurance coverage and obtains authorizations if needed.
• Process prior authorization requests received via phone, fax or correspondence following internal policies and procedures accurately timely and with attention to detail
• Completes and appropriately forwards all authorization requests to clinicians timely for medical review
• Enters referrals and documents communications, actions and other data in departmental systems.
• Provides authorization for inpatient admission, outpatient certification and/or prior authorization requests.
• Demonstrates proficiency in assigned UM Coordinator activities and will perform these UM Coordinator activities to ensure unit goals are met in the face of staffing or technology concerns. Maintains access to all assigned programs and technology to ensure that they can assume any activity as needed by the unit
• Meets or exceeds all proficiency, productivity, accuracy standards set for the UM Coordinator II level
• Acts as a liaison between hospitals, physicians, health plans, vendors, patients or referral sources.
• May assist supervisor with the management of daily activities over a group of UM Coordinators, including:
• Provides onboarding training for new staff, as needed
• Precept new staff for smooth post training transition and report performance issues as appropriate
• May provide guidance and expertise to less experienced UM Coordinators

Job Requirements

• Strong analytical skills and the ability to use sound judgment and resolve problems with minimal guidance or supervisor.
• The ability to use sound judgment and resolve problems with moderate guidance from lead staff and/or supervisor.
• Skills to communicate effectively to all levels of employees.
• Excellent oral and written communication skills.
• Excellent organizational skills.
• Strong interpersonal skills
• Knowledge of medical terminology required.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point)
• Familiarity with Medical management, electronic medical record and documentation programs
• Consistent word processing speed and accuracy of 50 or more words per minute.
• Knowledge/experience with NCQA Utilization Management guidelines is highly desirable
• Knowledge/experience with CMS regulatory requirements is highly desirable
• Basic understanding of LCD/NCD and overall functions of Utilization Management

Required Experience

• 2+ years related work experience

Education

• High school diploma or GED
• Bachelor's degree (preferred)