Utilization Management Coordinator II

ICONMA; Jacksonville (FL); Remote; USD 55,000 - 70,000; Full time

Job summary

A Mutual Insurance Holding company is seeking a Utilization Management Coordinator II for a remote position. Responsibilities include determining eligibility, managing referrals, and ensuring adherence to insurance coverage policies. Candidates should have strong analytical skills, experience in a related field, and proficiency in Microsoft Office. The company offers competitive health benefits and excellent growth opportunities.

Benefits

Health Benefits

Referral Program

Excellent growth and advancement opportunities

Qualifications

• 2+ years related work experience.
• Knowledge/experience with NCQA Utilization Management guidelines is highly desirable.
• Call center experience preferred.

Responsibilities

• Determines contract and benefit eligibility.
• Manages clinical referrals for members.
• Provides onboarding training for new staff.

Skills

Strong analytical skills

Excellent oral and written communication skills

Strong interpersonal skills

Excellent organizational skills

Proficiency with Microsoft Office Suite

Knowledge of medical terminology

Education

High school diploma or GED

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Our Client, a Mutual Insurance Holding company, is looking for a Utilization Management Coordinator II for their Remote location.

Responsibilities:

• Determines contract and benefit eligibility
• Initiates and manages clinical referrals for members.
• Verifies insurance coverage and obtains authorizations if needed.
• Processes prior authorization requests received via phone, fax or correspondence following internal policies and procedures accurately, timely, and with attention to detail
• Completes and appropriately forwards all authorization requests to clinicians timely for medical review
• Enters referrals and documents communications, actions, and other data in departmental systems.
• Provides authorization for inpatient admission, outpatient certification, and/or prior authorization requests.
• Demonstrates proficiency in assigned UM Coordinator activities and will perform these UM Coordinator activities to ensure unit goals are met in the face of staffing or technology concerns.
• Maintains access to all assigned programs and technology to ensure that they can assume any activity as needed by the unit
• Meets or exceeds all proficiency, productivity, accuracy standards set for the UM Coordinator II level
• Acts as a liaison between hospitals, physicians, health plans, vendors, patients, or referral sources.
• Provides onboarding training for new staff, as needed
• Precepts new staff for smooth post-training transition and reports performance issues as appropriate
• May provide guidance and expertise to less experienced UM Coordinators

Requirements:

• 2+ years related work experience
• High school diploma or GED
• Strong analytical skills and the ability to use sound judgment and resolve problems with minimal guidance or supervisor.
• The ability to use sound judgment and resolve problems with moderate guidance from lead staff and/or supervisor.
• Skills to communicate effectively to all levels of employees.
• Excellent oral and written communication skills.
• Excellent organizational skills.
• Strong interpersonal skills
• Knowledge of medical terminology required.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point)
• Familiarity with Medical management, electronic medical record, and documentation programs
• Consistent word processing speed and accuracy of 50 or more words per minute.
• Bachelor’s degree
• Preferred Licenses and Certifications
• Knowledge/experience with NCQA Utilization Management guidelines is highly desirable
• Knowledge/experience with CMS regulatory requirements is highly desirable
• Basic understanding of LCD/NCD and overall functions of Utilization Management
• Call center experience
• Insurance experience
• Jiva experience

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.