Utilization Management Coordinator I

Job Title: Utilization Management Coordinator I

Type: Short-term contract (3 mos)

Compensation: $24.67

Work Model: Remote – offsite. Must work east coast hours.

Hours: 8 hours per day, 40 hours per week. 5 days on, 2 days off in a row.
Training: Monday thru Friday the first month or so.
After Training: Schedule will be either Tuesday thru Saturday – OR - Sunday thru Thursday.

Responsibilities

• Support Utilization Management clinical teams by assisting with non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care
• Perform member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation
• Review authorization requests for initial determination and triage for clinical review and resolution
• Provide general support and coordination services for the department such as answering and responding to telephone calls, managing correspondence, researching information, and assisting in problem-solving
• Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and Peer to Peer reviews

• High School Diploma or equivalent
• At least 1 to 3 years of experience in health care claims/service areas or office support
• Two years of experience in health care/managed care setting or related work experience
• Knowledge of CPT and ICD-10 coding
• Effective communication, data entry, medical terminology, and medical knowledge skills
• Ability to participate in multi-disciplinary teams and demonstrate excellent communication, organizational, and customer service skills
• Knowledge of medical terminology and concepts in managed care
• Proficient in standardized processes for evaluating medical support operations
• Strong independent judgment and decision-making skills with tact and diplomacy
• Attention to detail
• Experienced with web-based technology and Microsoft Office applications including Word, Excel, and PowerPoint

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

Salary : $25