Remote Utilization Management Coordinator

About the Role

Jobgether is seeking a dedicated Remote Utilization Management Coordinator to join our team. This role is integral to supporting our clinical team by managing essential administrative and non-clinical tasks for processing Utilization Management (UM) prior authorizations and appeals. As a Remote Utilization Management Coordinator, you will ensure efficiency and accuracy within the UM process, providing a vital link between providers and our clinical staff.

What You'll Do

• Monitor incoming faxes for authorization requests.
• Enter UM authorizations review requests using ICD-10 and HCPCS codes.
• Verify eligibility and claims history in proprietary platforms.
• Ensure all necessary documentation is submitted with authorization requests.
• Contact providers to obtain required medical records.
• Generate correspondence for member and provider notifications.
• Complete verbal notifications and document activities.
• Initiate appeal cases for UM Nurses.
• Meet deadlines for UM cases as per internal and regulatory standards.
• Assist UM Nurses with designated tasks.

Requirements

• 1 year as a UM Coordinator in a managed care payer environment preferred.
• Knowledge of ICD-10, HCPCS codes, and medical terminology required.
• Strong time management and organizational skills to prioritize tasks.
• Proficient in computer applications like Word and Outlook.
• Ability to collect data, analyze facts, and draw valid conclusions.
• Effective written and oral communication skills required.
• Experience with DMEPOS is desired.
• Medicare/Medicaid experience is a plus.

Nice to Have

• Experience in a remote work environment.
• Familiarity with healthcare regulations and compliance.
• Certification in Utilization Management.

What We Offer

• Competitive compensation and annual bonus program.
• 401(k) retirement program with company match.
• Company-paid life insurance and short-term disability coverage.
• Medical, Vision, and Dental benefits.
• Paid Time Off (PTO) and Paid Parental Leave.
• Sick Time and Paid company holidays.
• Quarterly company-sponsored events.
• Health and wellness programs.
• Career development opportunities.