Coord, Utilization Mgmt I

KMM Technologies • Baltimore, MD

21h • Hybrid

About The Position

The Medical Management Coordinator provides non-clinical administrative support to Utilization Management clinical teams. The role includes triaging and entering appeals, screening incoming channels, creating shell cases in GuidingCare, and routing final decisions. It also involves coordinating medical record retrieval, issuing provider requests on a fixed cadence, and preparing review packets for medical directors and independent review organizations. The position requires provider communication and on-site mailing tasks. The role is hybrid in Baltimore, with in-office training and meetings in the Baltimore office once or twice each week. Only local candidates will be considered. Training includes medical records and overturn notices.

Requirements

• Core knowledge of CPT and ICD-10 coding.
• Knowledge of health care claims processing.
• Basic medical terminology used in managed care settings.
• Proficiency with GuidingCare, SharePoint, and Facets.
• Excellent communication skills.
• Local to the Baltimore/DMV area.
• Hands-on experience triaging appeals and managing medical record retrieval.

Responsibilities

• Triage and enter appeals.
• Screen incoming channels.
• Build shell cases in GuidingCare.
• Route final decisions.
• Manage medical record retrieval.
• Issue provider requests on a fixed cadence.
• Prepare review packets for medical directors and independent review organizations.
• Handle provider relations and on-site mailing tasks.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed