Licensed Utilization Management Coordinator

Job Summary

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

Key Responsibilities

• Monitor utilization of resources, risk management, and quality of care for patients
• Obtain and maintain documentation for services in line with reimbursement agency guidelines
• Input data into computer systems for insurance communication and monitor patient hospitalization for medical necessity

Required Qualifications

• Seven years of relevant experience, with at least one year in healthcare or clinical settings
• Current unencumbered Licensed Practical Nurse (LPN) license or Registered Health Information Technician (RHIT) certification
• Experience in healthcare reimbursement, insurance industry, and/or authorization is preferred
• Relevant coding certifications (e.g., CCS, CPC) are acceptable
• Must maintain required department-specific competencies and certifications