Utilization Management Coordinator

The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. 

JOB RESPONSIBILITIES

+ Monitor incoming faxes

+ Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes

+ Verify eligibility and claim history in proprietary claims platform

+ Verify all necessary documentation has been submitted with authorization requests

+ Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request

+ Generate correspondence and assist with faxing/mailing member and provider notifications

+ Complete verbal notifications

+ Document as required in authorization platform

+ Initiate appeal cases and forward to UM Nurses for completion

+ Meet internal and regulator deadlines for UM c...

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