MLTC Utilization Management Coordinator

Hamaspik Choice; Village of Spring Valley (NY); On-site; USD 30,000 - 41,000; Full time

Job summary

Hamaspik Choice is seeking an Utilization Management Coordinator to provide day-to-day administrative support within the UM department. The role includes handling telephonic inquiries, data entry, and upkeep of electronic medical records to ensure accurate processing of requests.

You will assist with processing allocations and modifications, manage appeals entry, and help coordinate notifications to members while maintaining strict confidentiality.

Qualifications

• Experience performing administrative, clerical, and data-entry tasks.
• Strong telephone etiquette and ability to handle member inquiries.
• Excellent organization and attention to detail.

Responsibilities

• Provide day-to-day administrative support to the Utilization Management department.
• Assist with telephonic communications and data entry related to UM requests.
• Maintain electronic medical records and member notices as required.
• Process authorization modifications and enter appeals into systems.
• Coordinate workflow and track work queues to ensure timely processing.
• Ensure notices are issued within established timeframes and delivered via preferred member contact method.
• Protect confidentiality of member information in all interactions.
• Support department leadership with miscellaneous duties as assigned.

Skills

Administrative tasks

Data entry

Telephone support

Record maintenance

Education

High school

Job description

• Location 775 North Main Street,Spring Valley, NY, 10977,United States
• Base Pay $22.00 - $30.00 / Hour
• Employee Type Full Time
• Required Degree High school

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.

• 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.