Utilization Management Support SpeciUtilization Intake Review Coordinatoralist

About the role

This organization operates as a third-party administrator specializing in self-funded employee benefit plans. It addresses the challenge employers face in finding affordable, quality health coverage by administering customized self-funded insurance benefits. With over 30 years of experience and a team exceeding 300 employees, the company manages claims, disputes, and specialized programs such as FSAs, HSAs, COBRA, and retiree billing, serving a broad regional client base.

The Utilization Intake Review Coordinator is responsible for managing the initial intake and data entry of clinical information necessary for utilization review processes. This role ensures timely review of authorization requests to support uninterrupted treatment for members, directly contributing to the effectiveness and efficiency of the utilization review department.

Responsibilities

• Assist with daily operations within the Utilization Review department as directed by lead staff
• Enter clinical and intake data accurately into designated platforms
• Maintain updated knowledge of utilization review processes and timelines
• Conduct outreach calls using established scripts and protocols, ensuring courteous and professional communication
• Process correspondence and referrals to clinical team members within set timeframes
• Perform clerical tasks such as scanning and document retrieval related to utilization review
• Communicate resolutions clearly and professionally
• Adhere to Standard Operating Procedures and maintain knowledge of member benefits and rights
• Interpret plan language to apply appropriately to intake tasks
• Comply with all company policies and procedures
• Complete additional duties and projects as assigned

Requirements

• High school diploma or equivalent
• 1 to 2 years healthcare experience
• Proficient in MS Office (Word, Excel, Outlook) and internet applications
• Strong reading comprehension
• Self-motivated and able to work independently
• Excellent communication and problem-solving skills

Benefits

• Medical, dental, and vision insurance after a waiting period
• Twice annual employer HSA contributions covering half the HDHP plan deductible
• Employer-paid Basic Life and AD&D insurance
• Company-paid Short-Term and Long-Term Disability insurance
• Flexible Spending Accounts
• 401(k) Retirement Plan with up to a 6% employer match, fully vested after 3 years
• Paid holidays and vacation time
• Paid half-day Summer Fridays
• Annual paid volunteer day
• Tuition reimbursement
• Health and wellness reimbursement
• Company events