Remote Clinical Operations Associate Utilization Management

healthoptions; Maine; Hybrid; USD 42,000 - 59,000; Full time

Benefits offered by this job

Competitive cash compensation

Comprehensive health plans

Generous PTO

Future focused 401k match

Job summary

Community Health Options is seeking a Clinical Associate, Utilization Management to support Medical Management and coordinate functions across UM, CM, DM, TOC, POS and HP. The role balances advocacy for individuals with stewardship for the entire membership and requires adaptability to changing daily priorities.

The position involves periodic in-office work with remote options based on operational needs and supervisor approval, while maintaining high quality and productivity standards.

Qualifications

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

Responsibilities

• Provides administrative support of daily operations to include UM, CM, DM, TOC, POS and HP.
• Monitors utilization management incoming fax queue and creates new authorization shells.
• Updates authorization with applicable supporting/clinical documentation upon receipt.
• Successfully complete eligibility assessments in newly established authorizations.
• Monitor incoming phone calls and triages calls to the appropriate team member based on established workflows.
• Monitors outbound UM phone queue and contacts providers when additional information is needed to process an authorization request; documents updated information.
• Maintains confidentiality in all aspects of Member, Health Options people and company information.

Skills

Medical terminology

English proficiency

Microsoft Office

Education

Associate Degree in health related field

Tools

Microsoft Office

Job description

Community Health Options is seeking a Clinical Associate, Utilization Management to support Medical Management and coordinate functions across UM, CM, DM, TOC, POS and HP. The role balances advocacy for individuals with stewardship for the entire membership and requires adaptability to changing daily priorities.

The position involves periodic in-office work with remote options based on operational needs and supervisor approval, while maintaining high quality and productivity standards.