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Clinical Utilization Coordinator

2 months ago

Owings Mills, Maryland, United States System One Holdings, LLC Full time

Company: System One Holdings, LLC

Position: Utilization Management Coordinator

Overview:
System One Holdings, LLC is seeking a dedicated Utilization Management Coordinator to enhance the operations of a prominent health insurance provider. This role is essential in supporting the clinical teams by managing various non-clinical administrative functions associated with pre-service, utilization assessments, care coordination, and ensuring quality care delivery.

Compensation: $24/HR
Work Environment: Fully Remote
Location Requirement: Must reside in the DMV area

Key Responsibilities:

  • Evaluate authorization requests for initial assessments and facilitate referrals for clinical evaluation and resolution.
  • Provide comprehensive support and coordination for the department, which includes managing incoming calls, taking messages, handling correspondence, conducting research, and assisting in problem resolution.
  • Assist in reporting, data management, and the organization of information related to the Continuity of Care process and the tracking of Peer to Peer reviews.
  • Perform administrative support tasks related to members or providers.