Utilization Management Coordinator

A company is looking for a Utilization Management Coordinator to process prior authorization requests and ensure compliance with regulatory guidelines.

Key Responsibilities

Process prior authorization requests and ensure adherence to internal policies and regulatory guidelines

Forward requests to clinicians for medical review and communicate approved procedures to providers and members

Maintain logs and records, participate in departmental statistics compilation, and engage in process improvement activities

Required Qualifications

Two to four years of experience in UM healthcare management or equivalent education and experience

Experience in a Health Care Management or HMO environment

Familiarity with utilization review / utilization management processes

Basic understanding of LCD / NCD and Utilization Management functions

Strong computer skills, particularly in MS Office products, including MS Excel