Utilization Management Coordinator

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Assist in the administration of Utilization Management functions, which includes organizing workflows, facilitating communications, interpreting information, tracking follow-ups, conducting research, and generating reports.

• Support Utilization Management operations and payer communications to secure admission approvals through clinical reviews and appeals processes.

• Aid in Care Coordination communications with payers by implementing effective workflow processes.

• Oversee and process incoming payer faxes, which involves renaming, uploading approvals, tracking bed days, and managing denials.

• Ensure that approvals are consistent with the current patient classification and escalate any discrepancies or conflicting communications from payers.

• Accurately document authorization, certification, communications, and clinical data within EMR/EPIC systems.

• Collaborate with Utilization Management nurses and payers regarding clinical documentation and authorization criteria.

• Initiate the documentation for concurrent denials and coordinate peer-to-peer reviews with physician advisors.

• Engage in clerical tasks and revenue-enhancing activities, manage assigned work queues, and adhere to productivity benchmarks.

• Follow up with payers concerning fax failures, deferred accounts, and additional approved days.

• Communicate issues related to coverage, admission notifications, patient calls, and operational matters to the relevant teams or leadership.

• Perform reporting, research, meeting scribe responsibilities, new-hire onboarding, and other assigned tasks.

⛳️ Requirements

• High School Diploma or GED - Required

• Associate's Degree - Preferred

• At least 1 year of clerical support experience - Required

• A minimum of 1 year of administrative support experience in the healthcare sector - Preferred

• Understanding of utilization management, case management, medical insurance, medical office operations, hospital business office functions, pre-services, admissions, registration, billing, or collections workflows.

• Capability to organize and prioritize workflow effectively and manage assigned work queues.

• Proficiency in interpreting critical information and ensuring follow-up tracking.

• Strong communication skills to interact with internal departments, external payers, Utilization Management nurses, Care Coordination teams, and leadership.

• Competency in documenting appropriately within EMR/EPIC systems.

• Ability to manage payer faxes and comply with payer clinical documentation requirements.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with company matching.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on work-life balance.