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Utilization Management Coordinator
1 month ago
Job Title: Utilization Management Coordinator(Hybrid)
Client: Health Care Industry
Duration: 12 months contract with possible extension
Location: Baltimore, MD, 21224 (DMV Candidates only, District of Columbia, Maryland and Virginia)
Job Description:
Purpose:
Support Utilization Management clinical teams by assisting with non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care.
Top 5 Required Skills:
Medical background, computer skills, medical terminology, claims and service office support, CPT and ICD-10 coding
Essential Functions:
- 35% Perform member or provider related administrative support (e.g., benefit verification, authorization management, claims inquiries, case documentation)
- 35% Review authorization requests for initial determination or triage for clinical review
- 20% Provide general departmental support (e.g., answering calls, correspondence, problem-solving)
- 10% Assist with reporting, data tracking, and organization (e.g., Continuity of Care process, Peer to Peer reviews)
Qualifications:
- High School Diploma
- 3 years' experience in health care claims/service areas or office support
Preferred Qualifications:
- Two years' experience in health care/managed care setting or previous division work experience
- Knowledge of CPT and ICD-10 coding
Knowledge, Skills, and Abilities (KSAs):
- Ability to participate effectively in multi-disciplinary teams
- Excellent communication, organizational, and customer service skills
- Knowledge of basic medical terminology and managed care concepts
- Familiarity with standardized processes and procedures in medical support operations
- Strong independent judgment, decision-making skills, tact, and diplomacy
- Attention to detail in project or task management
- Proficiency in web-based technology, Microsoft Office applications (Word, Excel, PowerPoint)
