Healthcare Utilization Coordinator

As a Healthcare Utilization Coordinator, you will work under the direction of the Associate Director Clinical Utilization & Analysis. With a focus on reviewing claims data of medically complex individuals experiencing significant addiction and/or behavioral health conditions, attention to detail is crucial for this role. The position is full-time (40 hours /week) Monday - Friday. Travel is 0-10% within the state. The role offers the flexibility of telecommuting from anywhere within the U.S.

• Review member's claims data
• Collaborate with the Medical Director to discuss member utilization patterns
• Educate providers on health plan Lock-In program
• Partner with care team (community, providers, internal staff)
• Develop knowledge of community cultures and values

Preferred Qualifications:

• Bachelor's Degree (or higher) in a health-related field
• Previous care management experience
• Experience in Managed Care and knowledge of Medicaid and/or Medicare population
• Familiarity with vulnerable subpopulations including members with homelessness, substance use disorders, and complex chronic conditions