Job Details

Job Description:

• The Utilization Management Coordinator provides administrative and coordination support related to member and provider services.
• This role focuses on authorization processing, claims-related support, departmental coordination, reporting, and data tracking while ensuring accuracy, compliance, and effective communication across teams.

• Perform member and provider administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation.
• Review authorization requests for initial determination and triage cases for clinical review and resolution.
• Provide general departmental support including answering calls, responding to inquiries, taking messages, preparing correspondence, researching information, and assisting with problem resolution.
• ssist with reporting, data tracking, data gathering, organization, and dissemination of information including Continuity of Care processes and Peer-to-Peer review tracking.

• Three years of experience in healthcare claims, healthcare service areas, or office support.

• Experience in a healthcare or managed care setting.
• Knowledge of CPT and ICD-10 coding.

• Strong communication, organizational, and customer service skills.
• bility to work effectively within a multidisciplinary team including internal and external participants.
• Knowledge of basic medical terminology and managed care concepts.
• bility to apply standardized processes and procedures for evaluating medical support operations.
• Strong independent judgment and decision-making skills with tact and diplomacy.
• High attention to detail.
• Proficiency in web-based technology and Microsoft Office applications including Word, Excel, and PowerPoint.

• High school diploma or equivalent.