Licensed Utilization Management Coordinator

Job Summary

A company is looking for a Utilization Management Coordinator (Home-Based) - Prior Authorization.

Key Responsibilities

• Monitor resource utilization, risk management, and quality of care in accordance with established guidelines
• Obtain and maintain documentation for services to ensure compliance with reimbursement agency guidelines
• Input data into systems for insurance communication and assist with medical records coding as needed

Required Qualifications

• Seven years of relevant experience with a minimum of one year in healthcare or clinical settings
• Current unencumbered Licensed Practical Nurse (LPN) license or Registered Health Information Technician (RHIT) certification
• Relevant certifications in coding or pharmacy, such as Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
• Experience in healthcare reimbursement, insurance industry, and/or authorization processes is preferred
• Ability to maintain required department-specific competencies and certifications