Terms of Employment • Contract, 12 Months • This position is primarily remote. With that said, candidates must reside in Maryland for onsite training and "All Hands" meetings. • The schedule is Monday - Friday, 8:15 AM - 5:00 PM (Eastern) with an hour-break.
Overview • Our client is looking for a Utilization Management Coordinator who can support the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care. The Utilization Management Coordinator will be working in a team environment, responsible for entering, routing, and updating patient cases that are lacking a discharge date using a care management software platform. The Utilization Management Coordinator will receive cases from the Manager of Clinical Support on a daily basis, review the information for discharge date information, and contact provider offices and/or facilities to gather this information if it is missing in an effort to close out the cases so claims can be fully processed.
Required Skills & Experience • High School Diploma and 3+ years of experience in an administrative position in the healthcare / health insurance industries. • Strong skills in data entry, to include managing patient information. • Ability to effectively participate in a multi-disciplinary team including internal and external participants. • Excellent communication, organizational, and customer service skills. • Knowledge of basic medical terminology and concepts used in managed care. • Knowledge of standardized processes and procedures for evaluating medical support operations business practices. • Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy. • Ability to pay attention to the minute details of a project or task. • Microsoft Office applications such as Word, Excel, Outlook and Teams.
Preferred Skills & Experience • Knowledge of healthcare claims. • Knowledge of CPT and ICD-10 coding. • Experience using a claims management platform such as GuidingCare. • Experience using CareManager. • Experience using Facets solutions. • Experience using NASCO solutions.