CareFirst of Maryland-posted about 1 year ago
$35,280 - $64,680/Yr
Full-time
Remote • Baltimore, MD
Ambulatory Health Care Services

The Utilization Management Coordinator supports the clinical teams by handling non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. This remote position focuses on government programs, including Medicare Advantage and Maryland Medicaid, and requires occasional in-person attendance at CareFirst locations for meetings and training.

  • Perform member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation.
  • Review authorization requests for initial determination and triage for clinical review and resolution.
  • Provide general support and coordination services for the department, including answering and responding to telephone calls, taking messages, and assisting in problem-solving.
  • Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
  • High School Diploma or GED.
  • 3 years of experience in health care claims/service areas or office support.
  • Two years' experience in a health care/managed care setting or previous work experience within the division.
  • Knowledge of CPT and ICD-10 coding.
  • Previous experience working with Medicare/Medicaid enrollees and benefits.
  • Comprehensive benefits package
  • Various incentive programs/plans
  • 401k contribution programs/plans
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