[Remote] Utilization Management Coordinator Remote (Strong Internal) 2025-1450

Note: The job is a remote job and is open to candidates in USA. Sedgwick Government Solutions is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. They are seeking a Utilization Management Coordinator to assist the UM team by facilitating the intake of authorization requests, obtaining medical records, and providing general support to clinical staff in a team environment.


Responsibilities

  • Collaborates as an integral member of the WTC-NPN utilization team and the broader case management team.
  • Maintains clear communication and coordinates resources effectively.
  • Works toward the shared goal of creating and nurturing a caring environment.
  • Supports improved quality of life for Members.
  • Contributes to reducing health care costs for the Program. Accesses, triages and assigns cases for utilization review (UR).
  • Responds to telephone inquiries proving accurate information and triage as necessary.
  • Enter demographics and UR information into claims or clinical management system; maintains data integrity.
  • Obtains all necessary information required for UR processing from internal and external sources to policies and procedures.
  • Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
  • Support other units as needed.
  • Applies knowledge and experience in a healthcare environment as support to the UM team.
  • Maintains privacy, as per Program guidelines, within a secure environment of documentation and communication.
  • Understands the organization's quality management program and the care coordinator’s role within that program, with compliance of all SOPs within the Program’s Operations Manual.
  • Is an effective team member; supports the team by pitching in at any level and effectively working across the organization to meet the needs of the case management program.
  • Takes ownership of personal actions and outcomes.
  • Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
  • Ability to work independently, multitask, and adjust priorities.
  • Proactively seeks opportunities to increase knowledge, skills, and abilities.
  • May perform other duties, as needed, to meet the needs of the business.

Skills

  • 2+ years’ experience in medical record review, triage, customer service, prior authorizations, medical claims, and billing, assessing patient health, and/or related experience.
  • Excellent written and verbal communication skills to collaborate with all stakeholders and team members.
  • Strong organizational skills
  • Excellent interpersonal skills
  • Ability to work in a team environment
  • Proficiency in computer use, including Microsoft Office Word, PowerPoint, Excel, and Outlook.
  • Must be a US citizen.
  • Ability to obtain and maintain security clearance.
  • Must pass credit, education, and background checks.
  • Ability to travel on occasion

Education Requirements

  • High School diploma, associate’s degree (or higher) in clinical or medical health administration, or related field preferred

Benefits

  • Medical
  • Dental
  • Vision
  • 401 (k) and matching
  • PTO
  • Disability and life insurance
  • Employee assistance
  • Flexible spending or health savings account
  • Other additional voluntary benefits

Company Overview

  • Sedgwick Government Solutions helps people and empowers performance through claims and productivity management solutions tailored to the needs of federal employees and government agencies. It was founded in 1997, and is headquartered in Bethesda, Maryland, USA, with a workforce of 201-500 employees. Its website is https://mcacares.com.

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