Utilization Mangement Coordinator, (Remote)

CareFirst of Maryland • Baltimore, MD

393d • $35,280 - $64,680 • Remote

About The Position

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.

Requirements

• High School Diploma or GED.
• 3 years of experience in health care claims/service areas or office support.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• Comprehensive benefits package
• Various incentive programs/plans
• 401k contribution programs/plans

What This Job Offers

• Job Type: Full-time
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED