Utilization Management Coordinator

Utilization Management Coordinator

Work setup: 100% Remote (must be able to work Eastern Time hours)
Schedule:Must be able to work weekends
Contract length: ~3 months
Pay: $24.50/HR

Role overview

This role supports a Utilization Management/Medical Management team by handling high-volume prior authorization administrative work and related documentation. The work is fax-only (no calls) and requires strong accuracy, speed, and comfort with medical terminology and authorization workflows.

What you’ll do

• Create and manage prior authorization requests (data entry + processing)
• Review incoming authorization requests and triage for clinical review when needed
• Document activity accurately and keep cases organized and up to date
• Support the team with general coordination tasks and tracking/reporting as needed
• Work in a high-volume environment with a minimum of 32+ faxes per day

Must-have qualifications (required)

• 1+ year of experience as a Utilization Management Coordinator / Medical Management Coordinator (or very similar)
• Hands-on experience with:
  • Prior authorization entry (most important)
  • Prior authorization processing
• Strong medical terminology knowledge
• Proven ability to keep up with high-volume throughput (32+ faxes/day minimum)
• Excellent communication, organization, attention to detail, and ability to multitask
• Own computer (required)
• High School Diploma (or equivalent)

Nice-to-have / preferred

• Guiding Care (highly preferred) — especially auth entry module experience building prior auths
• FACETS (preferred) — used for eligibility verification/lookup
• ICD-10 / diagnosis code familiarity
• Two monitors for productivity

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

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