Lead Utilization Management Coordinator - Remote at Jobgether – Delaware
Jobgether
Delaware, United States
Posted on
NewJob Function:Medical
New job! Apply early to increase your chances of getting hired.
Explore Related Opportunities
Medical and Health Services Managers jobs in DelawareJobs in DelawareMedical and Health Services Managers jobs
About This Position
Lead Utilization Management Coordinator - Remote
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Coordinator - REMOTE. In this role, you will support the clinical team by handling administrative and non-clinical tasks essential for processing Utilization Management prior authorizations and appeals. Your contributions will ensure the efficiency and accuracy of operations within the UM process. You will play a key role in enhancing communication with providers and managing documentation requirements. This position requires strong organizational skills and the ability to adapt to a dynamic work environment, making a real difference in healthcare management.
Accountabilities- Monitor incoming faxes for authorization requests
- Enter UM authorizations review requests using ICD-10 and HCPCS codes
- Verify eligibility and claims history in proprietary platforms
- Ensure all necessary documentation is submitted with authorization requests
- Contact providers to obtain required medical records
- Generate correspondence for member and provider notifications
- Complete verbal notifications and document activities
- Initiate appeal cases for UM Nurses
- Meet deadlines for UM cases as per internal and regulatory standards
- Assist UM Nurses with designated tasks
- Handle inquiries from call center and other sources
- Perform other duties assigned by the UM Director
- 1 year as a UM Coordinator in a managed care payer environment preferred
- Knowledge of ICD-10, HCPCS codes, and medical terminology required
- Strong time management and organizational skills to prioritize tasks
- Proficient in computer applications like Word and Outlook
- Ability to collect data, analyze facts, and draw valid conclusions
- Effective written and oral communication skills required
- Experience with DMEPOS is desired
- Medicare/Medicaid experience is a plus
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance and short-term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO) and Paid Parental Leave
- Sick Time and Paid company holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Why Apply Through Jobgether?
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
#LI-CL1
Scan to Apply
Just scan this QR code to apply from your phone.
Job Location
Delaware, United States
Frequently asked questions about this position
Latest Job Openings in Delaware
Mental Health Clinician (LCSW, LPCMH, PsyD or equivalent)
VitalCore Health Strategies
Smyrna, DE
Rental Advisor
Curtis Lane Holdings LLC
Delmar, DE
Diesel Technician
Curtis Lane Holdings LLC
Delmar, DE
CDL-A - Dedicated Reefer nighttime truck driver - Lidl
Schneider
Wilmington, DE
Substance Use Disorder Program Clinical Supervisor
VitalCore Health Strategies
Georgetown, DE
Continue to apply
Enter your email to continue. You’ll be redirected to the employer’s application.By clicking Continue, you understand and agree to JobTarget's Terms of Service and Privacy Policy.
Apply Now