Remote Medical Management Coordinator

Quartz Health Solutions; Wisconsin; Hybrid; USD 29,000 - 36,000; Full time

Benefits offered by this job

Remote work option

Job summary

Quartz Health Solutions is seeking a detail-oriented Medical Management Assistant to support the Utilization Management team in Wisconsin. The role handles NCQA-compliant determinations and provides comprehensive patient/provider support for pre-service, concurrent, and post-service requests.

Responsibilities include notifying nursing staff, making protocol-driven approvals, and assisting with referrals, prior authorizations, and claims reviews, while delivering excellent telephone customer

Qualifications

• Requires high school diploma or equivalent.
• 1+ year healthcare/claims processing experience.
• Proficient in MS Office; Epic experience preferred.
• Excellent attention to detail and organization; strong communication.

Responsibilities

• Provides notification to nursing staff of requests/hospitalizations requiring review.
• Makes approval determinations per protocols; refers medical questions to nursing staff.
• Assists in medical review for referrals, prior authorizations, inpatient & claims reviews with supporting information.
• Provides telephone customer service regarding authorization requests, hospitalizations, and claims questions.

Skills

Communication skills

Attention to detail

Organizational skills

Education

High school diploma or equivalent

1+ year healthcare environment experience

MS Office and Epic experience

Data entry and word processing experience

Knowledge of NCQA requirements

Medical terminology knowledge

Strong written and verbal communication

Customer service in healthcare setting

Job description

Quartz Health Solutions is seeking a detail-oriented Medical Management Assistant to support the Utilization Management team in Wisconsin. The role handles NCQA-compliant determinations and provides comprehensive patient/provider support for pre-service, concurrent, and post-service requests.

Responsibilities include notifying nursing staff, making protocol-driven approvals, and assisting with referrals, prior authorizations, and claims reviews, while delivering excellent telephone customer