Utilization Management Intake Coordinator remote- MediGold Health Plan

About the position Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. Position Purpose The Coordinator, Utilization Management Intake performs duties to support the Utilization Management department including management of internal and external calls, managing/triaging all departmental authorization/referral requests and assisting in compliance-driven auditing and reporting.

Responsibilities

• Assists with the management of departmental processes, auditing and reporting deliverables and initiatives in compliance with federal and state regulatory agencies.
• Receives, interprets and responds to evaluation utilization review inquiries
• Manages incoming medical records, authorization requests and referrals for department.
• Manages department call tracking system and triage incoming calls as appropriate.
• Coordinates, oversees, records and transmits information pertinent utilization review processes.
• Assists with administrative responsibilities such as meeting preparation, minutes, mailings faxing/scanning department records, ordering of departmental supplies, etc.
• Responsible for performing a variety of tasks requiring independent judgement and initiative.
• Establishes and maintains effective working relationships with other departments.
• Establishes and maintains strong positive communication with key stakeholders.

Requirements

• Education : High School required; Bachelor's degree preferred
• Experience: Minimum of two (2) years data entry experience, with healthcare field preferred.
• Effective Communication Skills
• Understanding of medical terminology required.
• Must have in-depth computer skills including word processing software (e.g. Microsoft Office) and data entry.
• Ability to work independently with minimal supervision.
• Must be able to document data accurately into computer system, and maintain statistical records and reports.
• Must possess a high degree of motivation, initiative and organizational ability.
• Familiarity with managed care and claims processing required, including CPT & ICD-10
• coding, phone triaging, referrals and authorizations.
• Must be able to maintain confidentiality of work documents.
• Knowledge of managed care issues related to utilization management, plan benefits and provider contacts.
• Ability to work with physician offices in facilitating authorizations.

Benefits

• Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers.
• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

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