Sr. Utilization Management Specialist (Remote)

Jobgether

3d • Remote

About The Position

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Coordinator - REMOTE. In this role, you will support the clinical team by handling administrative and non-clinical tasks essential for processing Utilization Management prior authorizations and appeals. Your contributions will ensure the efficiency and accuracy of operations within the UM process. You will play a key role in enhancing communication with providers and managing documentation requirements. This position requires strong organizational skills and the ability to adapt to a dynamic work environment, making a real difference in healthcare management.

Requirements

• 1 year as a UM Coordinator in a managed care payer environment preferred
• Knowledge of ICD-10, HCPCS codes, and medical terminology required
• Strong time management and organizational skills to prioritize tasks
• Proficient in computer applications like Word and Outlook
• Ability to collect data, analyze facts, and draw valid conclusions
• Effective written and oral communication skills required

Nice To Haves

• Experience with DMEPOS is desired
• Medicare/Medicaid experience is a plus

Responsibilities

• Monitor incoming faxes for authorization requests
• Enter UM authorizations review requests using ICD-10 and HCPCS codes
• Verify eligibility and claims history in proprietary platforms
• Ensure all necessary documentation is submitted with authorization requests
• Contact providers to obtain required medical records
• Generate correspondence for member and provider notifications
• Complete verbal notifications and document activities
• Initiate appeal cases for UM Nurses
• Meet deadlines for UM cases as per internal and regulatory standards
• Assist UM Nurses with designated tasks
• Handle inquiries from call center and other sources
• Perform other duties assigned by the UM Director

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance and short-term disability coverage
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO) and Paid Parental Leave
• Sick Time and Paid company holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed