Utilization Management Coordinator

Utilization Management Coordinator responsible for coordinating the appeal activities and UM process, including initiating Case Management, requesting pre-certification, submitting Medical Reviews, and Independent Dispute Resolution. Interfaces with managed care organizations and cost containment vendors to coordinate reviews for medical necessity; maintains files/logs for all appeals; prepares responses to inquiries from employers, members, and providers; participates in meetings and supports special projects. Fully remote position with HIPAA-compliant offsite work as needed. Requires strong administrative/technical skills, proficient in Microsoft Office and Teams, and excellent communication and confidentiality practices.