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Job Details

Utilization Management Coordinator Remote (Strong Internal) 2025-1450

Dallas, TX, USA

Medical Services

Full Time

Description

Utilization Management Coordinator (Strong Internal)- Remote

Overview

Are you looking to make a difference by providing high-quality care with a personal touch that impacts the lives of members of the World Trade Center Health Program? Would you like to be part of a team focused on empowering and sustaining health by supporting members? Do you have experience in medical records, triage, customer service, authorizations, claims and billing, patient health assessment, or other related healthcare support to assist our Members?

The UM Coordinator assists the UM team by facilitating the intake of authorization requests, obtaining medical records, assigning utilization review requests; to verify and enter data in appropriate system(s); and to provide 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.

Qualifications

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

+ 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

For a career path that is both challenging and rewarding, join Sedgwick Government Solution’s talented team. Taking care of people is at the heart of everything we do. Our clients depend on our talented colleagues to take care of their most valuable assets, their employees, and their customers. At Sedgwick Government Solutions, caring counts®. Join our team of creative and caring people of all backgrounds and help us make a difference in the lives of others.

Sedgwick Government Solutions provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors, including but not limited to skill set, level of experience, and cost of a specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($22/hr- $24/hr). A comprehensive benefits package is offered, including but not limited to medical, dental, vision, 401 (k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

To be considered for this position, please submit a resume and complete the application.

_The information provided above has been designed to indicate the general nature and level of work of the position. It is not a comprehensive inventory of all duties, responsibilities, and qualifications required._

Important Information

Successful candidates will be required to undergo a financial and criminal background check and obtain and maintain confidential-level security clearance upon hire. We participate in the United States Federal Government E-Verify program to confirm the employment authorization of the employee upon hire.

Search Firm Representatives

Please be advised that Sedgwick Government Solutions (Government Solutions) is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, a valid written agreement and task order must be in place before any resumes are submitted to Government Solutions. All resumes submitted by search firms to any employee at Government Solutions without a valid written agreement and task order in place will be deemed the sole property of Government Solutions and no fee will be paid in the event that person is hired by Government Solutions.

Government Solutions strives to make our career site accessible to all users. If you need disability-related accommodation to complete the application process, please contact Government Solutions regarding accommodations.

_Sedgwick Government Solutions is an Equal Opportunity and Affirmative Action Employer_

All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, disability, marital status, national origin, race, religion, sex, sexual orientation, gender identity, veteran status, or any other classification protected by federal state or local laws as appropriate, or upon the protected status of the person’s relatives, friends or associates.

Sedgwick Government Solutions abides by the requirements of 41 CFR 60-741.5(a) (http://www1.eeoc.gov/employers/upload/eeoc\_self\_print\_poster.pdf) . This regulation prohibits discrimination against qualified individuals on the basis of disability and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified individuals with disabilities.

Sedgwick Government Solutions abides by the requirements of 41 CFR 60-300.5(a) (http://www1.eeoc.gov/employers/upload/eeoc\_gina\_supplement.pdf) . This regulation prohibits discrimination against qualified protected veterans and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified protected veterans.

About Sedgwick

Sedgwick Government Solutions is a fully owned subsidiary of Sedgwick. Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. The company provides a broad range of resources tailored to clients' specific needs in casualty, property, marine, benefits, and other lines. At Sedgwick, caring counts; through the dedication and expertise of more than 27,000 colleagues across 65 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact the bottom line. www.sedgwick.com Privacy | Sedgwick (https://www.sedgwick.com/privacy/) Terms and Conditions | Sedgwick (https://www.sedgwick.com/termsandconditions/)