MLTC Utilization Management Coordinator

Job Overview:

The Utilization Management Coordinator (UMC) is responsible for providing day-to-day administrative, telephonic, data entry, and clerical support to the Utilization Management (UM) department. This role supports the timely and accurate processing of utilization management requests, maintenance of electronic medical records, preparation and distribution of member notices, and coordination of departmental workflows. 

Essential Responsibilities:

·         Identify, review, and complete administrative tasks based on departmental needs.

·         Support the receipt, documentation, entry, and tracking of utilization management requests in accordance with established policies and workflows.

·         Assist with processing authorization modifications.

·         Entering appeals into the appropriate modules.

·         Identify cases requiring medical director review and ensure they are routed promptly and accurately for review.

·         Monitor and update utilization management work queues (WQs) to support timely processing and resolution of outstanding items.

·         Monitor the Worklog Manager to track pending activities, identify follow-up needs, and facilitate timely completion of assigned tasks.

·         Complete the clerical components of member notices in accordance with established procedures and applicable timelines.

·         Ensure notices are issued within established timeframes.

·         Coordinate the distribution of member notifications through the member’s preferred method of contact.

·         Maintain accurate, complete, and up-to-date records within the software system.

·         Upload, organize, and maintain documents in the appropriate electronic records and case files.

·         Answer designated departmental telephone lines and assist members with inquiries within the scope of the role.

·         Provide telephone coverage and general administrative support to ensure continuity of departmental operations.

·         Communicate professionally and courteously while maintaining the confidentiality of member information.

·         Perform other related duties as assigned by departmental leadership.

Required Education, Experience, and Licenses:

•          Graduate of High School

Benefits:

•         Medical, dental, and vision insurance
•          Generous PTO package
•          Multiple floating holidays
•          401 (K) with employer contribution