Utilization Management Coordinator - Remote

This is a Fully Remote Job
About Our Client:
The organization operates within the healthcare management sector, focusing on utilization management to ensure effective processing of clinical referrals and authorizations. It addresses challenges related to timely and accurate handling of healthcare treatment authorizations, aligning with health plan standards and contractual obligations.
About the Opportunity:
The UTILIZATION MANAGEMENT COORDINATOR role is designed to support clinical, management, and client activities within the utilization management program. This position is responsible for processing referrals and treatment authorization requests efficiently and accurately, ensuring compliance with established policies and health plan requirements. The role contributes to maintaining high-quality service delivery and timely authorization processes, which are critical to the organization's operational success.
Responsibilities:
Comply with utilization management policies and procedures, including annual reviews.
Process routine and urgent treatment authorization requests according to policy manuals.
Attach incoming notes to appropriate authorizations.
Manage referrals by directing them to the correct review queues.
Review, screen, and process daily assigned referrals in line with IPA and health plan turnaround time guidelines.
Verify benefits, eligibility, provider status, and facility contracting requirements.
Communicate with providers for clarifications or additional information.
Attend to provider and interdepartmental inquiries with exceptional customer service.
Report daily activities or issues to the utilization management lead.
Maintain confidentiality and strong relationships with health plans and external contacts.
Assist team members as needed to meet turnaround time expectations.
Perform other assigned duties.
Requirements:
High school diploma required; Bachelor's degree in Healthcare Administration is a plus.
Minimum two years of experience in managed care, IPA, or MSO environments preferred.
Knowledge of medical terminology and relevant coding systems (RVS, CPT, HPCS, ICD-9).
Proficiency in Microsoft applications.
Strong organizational, verbal, and written communication skills.
Ability to multitask, problem-solve, and work independently in a fast-paced setting.
Detail-oriented, punctual, and a reliable team player.
Pay Range and Compensation Package:
Compensation is $22.00 to $25.00 per hour.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company's career page or ATS.

Work arrangement
Yes