California Licensed Utilization Coordinator

Job Summary

A company is looking for a Utilization Management Coordinator (Work from home).

Key Responsibilities:

• Receive, review, and process incoming requests for authorization of medical services
• Coordinate with providers, members, and internal clinical staff to gather necessary documentation for utilization reviews
• Enter authorization requests and updates into the utilization management system accurately and promptly

Qualifications:

• High School Diploma or equivalent required; Associate's degree or healthcare certification preferred
• 2+ years of experience in health plan environment; experience in utilization management or case management support strongly preferred
• Capacity to interpret health plan benefit decisions
• Bilingual required (English/Spanish)
• Certification as a Medical Assistant preferred