Utilization Management Coordinator

There are ten (10) positions available for this opportunity. The Utilization Management (UM) Coordinator provides MSO referral management services. The UM Coordinator serves as a liaison between members, physicians, providers, and MSO staff, processing initial intake of information, assisting with authorization functions, and gathering information.

Position is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers. The incumbent is responsible for tasks/functions related to the MSO’s prior authorization and referral process including applying the MSO’s criteria and policies/procedures to authorization requests from medical professionals, clinical facilities, and ancillary providers.

The UM Coordinator will directly interact with providers, acting as a resource for their needs. SPECIFIC SKILLS NEEDED

• Excellent verbal and written communication skills
• Develop and maintain effective working relationships with all levels of staff, community agencies, providers, and members.
• Maintain an understanding of current CPT, ICD-10 and HCPCS codes and continual updates to knowledge base regarding the codes.
• Utilize prior authorization protocols to determine when to refer matters to a licensed staff person.
• Familiar with Ez. Cap
• Minimum typing speed of 40 wpm.
• Able to prioritize and delegate effectively.
• Attention to details.
• Excellent organizational skills.
• Must be familiar with Health Plan benefit verification
• Must have knowledge of medical terminology
• Proficient in Windows, Microsoft Word, and Excel. EDUCATION/EXPERIENCE/TRAINING Required:
• High School Graduate or equivalent certification.
• Minimum of two (2) years’ experience in a managed care or health plan environment Preferred:
• Passed the Bilingual Fluency Assessment for Clinicians (BFAC Certified) by Language Line Solutions