Utilization Management Coordinator – Casual

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

📋 Description

• Oversee all incoming authorizations.

• Serve as the main point of contact for both internal and external customers seeking information or assistance regarding authorizations.

• Evaluate authorization requests based on the established level of review criteria.

• Draft denial letters under the guidance of professional staff.

• Collaborate closely with professional staff and customer service to deliver precise technical information to provider offices and internal clients.

• Reach out to provider offices via phone to obtain missing clinical documentation required for medical review.

• Cross-train with all UM Coordinators to fully understand each process, ensuring coverage is consistently available.

• Maintain strict confidentiality of all health records and member information while adhering to HIPAA regulations.

⛳️ Requirements

• High school diploma is required.

• A minimum of two years of previous experience in Utilization Management, medical records, medical billing, or within a medical office.

• 2-3 years of experience with Microsoft Office programs is mandatory.

• A certificate or equivalent experience in medical terminology, CPT, HCPCS, and ICD coding is essential.

🏝️ Benefits

• Comprehensive medical, vision, and dental coverage.

• 401k savings plan with company matching.

• Flexible time off policy.

• 9 paid holidays.