Clinical Management Support Specialist (UM/CM/DM)

Maine Community Health Options; Northern (KY); Hybrid; USD 36,000 - 48,000; Full time

Job summary

Maine Community Health Options is seeking a Clinical Associate, Medical Management to support utilization management operations and coordinate across UM, CM, DM, TOC, POS, and HP services. The role requires nimbleness to adapt daily priorities and periodic in-office work with remote options based on needs and supervisor approval.

The ideal candidate has an associate degree in a health field, medical terminology background, and proficiency with Microsoft Office to maintain accurate clinical

Qualifications

• Associate degree in health related field preferred.
• Medical office or Health Plan experience preferred.
• Medical terminology background required.
• Working knowledge of ICD-10/CPT/HCPCS codes preferred.
• Proficient in English with verbal and written communications.
• Proficient with Microsoft Office and accurate clinical documentation.
• Ability to maintain production levels with minimal supervision.

Responsibilities

• Provides administrative support for UM, CM, DM, TOC, POS and HP.
• Monitors UM fax queue and creates new authorization shells.
• Updates authorizations with supporting documentation.
• Completes eligibility assessments in new authorizations.
• Monitors phone queues and triages calls per workflows.
• Contacts providers for information and documents updates.
• References approved resources and follows procedures.
• Maintains confidentiality of member and company information.
• Performs other project work as assigned.
• Demonstrates integrity, humility, curiosity, and discipline; strong communication and process-improvement mindset.

Skills

Medical terminology

Public communication

English proficiency

Education

Associate Degree in health related field

Tools

Microsoft Office

Job description

Maine Community Health Options is seeking a Clinical Associate, Medical Management to support utilization management operations and coordinate across UM, CM, DM, TOC, POS, and HP services. The role requires nimbleness to adapt daily priorities and periodic in-office work with remote options based on needs and supervisor approval.

The ideal candidate has an associate degree in a health field, medical terminology background, and proficiency with Microsoft Office to maintain accurate clinical