Healthcare Utilization Management Coordinator
On-siteMakati City, Metro Manila, Philippines or Makati, Cagayan Valley, Republic of the Philippines
Job Summary
Coordinate prior authorization, referral, and utilization review activities by receiving, reviewing, and processing incoming requests via fax and electronic submissions. Verify demographic and member information, prioritize urgent cases, and route requests to clinical reviewers while tracking status through completion. Manage document intake by retrieving faxed documentation, ensuring legibility, indexing records, and matching them to existing cases or creating new ones. Communicate with providers regarding incomplete requests, coordinate medical record retrievals, and escalate complex inquiries requiring clinical judgment. Maintain accurate authorization records, ensure HIPAA compliance, and support workflow updates and process improvement initiatives.
Required Qualifications
- High School Diploma or equivalent
- 1–3 years of experience in healthcare administration, utilization management, prior authorization, referrals, claims processing, provider services, medical records, or care coordination
- Knowledge of medical terminology
- Strong attention to detail and organizational skills
- Excellent verbal and written communication skills
- Ability to manage multiple priorities in a fast-paced environment
- Intermediate proficiency with Microsoft Office applications
Desired Qualifications
- Experience working within a health plan, managed care organization, IPA, TPA, medical group, or healthcare provider environment
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