Utilization Management Coordinator

1 week ago


Detroit, Michigan, United States McLaren USA Full time
Job Overview

We are seeking a skilled Utilization Management Coordinator to join our team at McLaren USA. This role will play a crucial part in determining hospital settings based on medical necessity, performing concurrent and retrospective utilization management activities, communicating with payors, and obtaining authorization for care.

Key Responsibilities:
  • Determine hospital settings based on medical necessity in collaboration with the UM RN.
  • Conduct concurrent and retrospective utilization management activities to ensure optimal patient care.
  • Communicate effectively with payors via phone, fax, and computer system to obtain necessary authorizations.
  • Provide prompt feedback regarding payor determinations to facilitate timely decision-making.
  • Attend meetings and prepare agendas and minutes to ensure seamless communication.
  • Handle office correspondence and phone calls to maintain efficient workflow.
  • Perform general office duties, including faxing, copying, and filing, to support administrative tasks.
Requirements:
  • An associate degree in a healthcare-related field.
  • Two years of clerical experience, preferably in a healthcare environment.
  • One year of experience utilizing medical terminology in a healthcare setting.
PREFERRED QUALIFICATIONS:
  • A bachelor's degree in coding/medical records/billing or a healthcare-related field.
  • Two years of case management or utilization review experience.
  • Three years of recent experience in third-party payer certification.


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