• Utilization Management Care Coordinator

    Job Location US-MI-Detroit
    Job ID
    Utilization Management
    Business Line
    CMC Corporate
  • Overview

    Who we are:

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.


    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.


    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.


    A Day in the Life of a Utilization Management Care Coordinator:


    This position works collaboratively with other members of the Utilization Management team to ensure that authorization requests, provider and member inquiries are handled appropriately, within established timeframes and utilizing established guidelines.



    • Receive and organize authorization requests and clinical information via fax or telephone for all lines of business as needed
    • Enter demographic data into MCS making certain that all data fields are correct and all necessary CPT, ICD-9 and diagnostic codes are entered. Utilize appropriate resources or contact provider offices to clarify information as needed
    • Enter a system approval for all PCP authorizable services
    • Forward corporate authorization requests and accompanying clinical information to licensed reviewers
    • Fax processed requests back to appropriate provider offices
    • Manage telephone inquiries by logging onto appropriate phone queue and handling or forwarding calls as appropriate
    • Conduct post inpatient calls
    • Provide support for processing denial and appeal letters as needed
    • Work with Transplant Coordinator to track and report transplant data Work the Inpatient Nurse Reviewers to obtain delivery information and discharge dates
    • Make outgoing calls to members to conduct outreach related to MHP clinical priorities
    • Assist in the collection of HEDIS data
    • Understand principles of HIPAA and maintain confidentiality Perform other duties as assigned such as faxing, filing and mailing


    What you can bring to Meridian:

    • High school diploma is required
    • Associate’s degree is required
    • Pursuit of a Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred
    • One to three years of related experience and/or training is required


    What Meridian can offer you:

    • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.


    Equal Opportunity Employer



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