Remote Medical Management Coordinator

Maine Community Health Options; Maine; Hybrid; USD 40,000 - 52,000; Full time

Job summary

Maine Community Health Options is seeking a Clinical Associate, Medical Management to support utilization management programs across UM, CM, DM, TOC, POS and HP. The role provides administrative support to ensure smooth operations and requires adaptability to daily priorities, with periodic in-office work and some remote work approved by a supervisor.

The candidate should have an associate degree in health field, medical terminology knowledge, and experience with ICD-10/CPT/HCPCS codes, plus

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.
• Proficiency in English with verbal, written, interpersonal and public communications.

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 in accordance with established standards.
• 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 in the applicable authorization template.
• Maintains confidentiality in all aspects of Member, Health Options people and company information.

Skills

Medical terminology

English proficiency

Typing

Accurate clinical documentation

Strong communication skills

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 programs across UM, CM, DM, TOC, POS and HP. The role provides administrative support to ensure smooth operations and requires adaptability to daily priorities, with periodic in-office work and some remote work approved by a supervisor.

The candidate should have an associate degree in health field, medical terminology knowledge, and experience with ICD-10/CPT/HCPCS codes, plus