Clinical Associate, Utilization Management

Community Health Options

. Provide administrative support for daily operations across Utilization Management, Case Management, Disease Management, Transitions of Care, Point-of-Service, and Health Promotion .

Posted 10/2/2026full-timeMaine • United StatesJuniorMid-Level💰 $42,400 - $59,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in medical terminology and ICD-10/CPT/HCPCS coding while providing administrative support in Utilization Management and Case Management. Maintains confidentiality and adheres to established procedures and workflows in a health-related environment.

Highest-signal resume keywords

Medical TerminologyICD-10 CodingCPT CodingUtilization ManagementMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CodingCPT CodingHCPCS CodingClinical DocumentationEligibility AssessmentsAuthorization ManagementFax Queue ManagementPhone TriageProject WorkQuality Standards Maintenance

Soft Skills

Interpersonal CommunicationCultural SensitivityWritten CommunicationPublic CommunicationAttention to Detail

Tools & Technologies

Microsoft Office

Certifications & Qualifications

Associate Degree in Health Related Field

Industry Keywords

Utilization ManagementCase ManagementDisease ManagementTransitions of CareHealth PromotionHealth Plan ExperienceConfidentialityMember Population

About the role

Key responsibilities & impact

Provide administrative support for daily operations across Utilization Management, Case Management, Disease Management, Transitions of Care, Point-of-Service, and Health Promotion
Monitor the utilization management incoming fax queue and create new authorization shells according to established standards
Update authorizations with applicable supporting and clinical documentation
Complete eligibility assessments in newly established authorizations
Monitor incoming phone calls and triage calls to the appropriate team member
Monitor the outbound UM phone queue and contact providers when additional information is needed
Document updated information in applicable authorization templates
Follow approved resources, department procedures, and workflows
Maintain confidentiality of member, employee, and company information
Perform assigned project work and supportive duties

Requirements

What you’ll need

Associate Degree in health related field, preferred
Medical office or Health Plan experience preferred
Medical terminology background, required
Working knowledge of ICD-10/CPT/HCPCS codes, preferred
Appreciation of cultural diversity and sensitivity towards individual preferences and needs of Member population
Proficient in English with verbal, written, interpersonal and public communications
Proficient with Microsoft Office products, typing, and ability to maintain accurate clinical documentation
Ability to maintain production levels and quality standards with minimal direct supervision

Benefits

Comp & perks

Competitive cash compensation
Comprehensive health plans
Generous PTO
Future focused 401k match
Flexible schedules to accommodate varying needs of our people
Professional development and training