Remote Clinical Associate - Utilization & Care Coordination

Maine Community Health Options; Lewiston (ME); Hybrid; USD 38,000 - 48,000; Full time

Job summary

Maine Community Health Options is seeking a Clinical Associate, Utilization Management to support daily UM/CM/DM/TOC/POS/HP operations. The role involves handling authorization workflows, documentation updates, and maintaining confidentiality while coordinating with multiple teams.

The position requires an Associate Degree in a health-related field, familiarity with medical terminology, and strong Microsoft Office skills.

Qualifications

• Associate degree in a health-related field preferred.
• Medical office or health plan experience preferred.
• Medical terminology background required.
• Knowledge of ICD-10/CPT/HCPCS codes preferred.

Responsibilities

• Provides administrative support for UM, CM, DM, TOC, POS and HP operations.
• Monitors fax queue and creates new authorization shells per standards.
• Updates authorizations with supporting/clinical documentation.
• Completes eligibility assessments in newly established authorizations.
• Triages incoming calls to appropriate team members per workflows.
• Monitors outbound UM calls and documents information in authorization templates.
• References approved resources and follows department procedures/workflows.
• Maintains confidentiality of member, Health Options, and company information.
• Performs other project work or duties as assigned.
• Leads with integrity, humility, curiosity, and discipline.

Skills

Medical terminology

Typing

Public communications

Education

Associate Degree in health related field

Tools

Microsoft Office

Job description

Maine Community Health Options is seeking a Clinical Associate, Utilization Management to support daily UM/CM/DM/TOC/POS/HP operations. The role involves handling authorization workflows, documentation updates, and maintaining confidentiality while coordinating with multiple teams.

The position requires an Associate Degree in a health-related field, familiarity with medical terminology, and strong Microsoft Office skills.