A Healthcare company is looking for a detail-oriented UM Coordinator to support utilization management operations for a healthcare organization in Long Beach, California. This UM Coordinator will manage prior authorization activity, maintain accurate records, and communicate effectively with providers in a fast-paced environment.
Key Responsibilities:
- Review and process prior authorization submissions using the designated authorization platform while ensuring each request is handled accurately and efficiently.
- Confirm member coverage details, benefit information, and provider network participation before authorization decisions move forward.
- Record case updates, communication history, and status changes in a clear and organized manner within the appropriate systems.
- Track request timelines for both urgent and routine cases to help maintain compliance with internal standards and regulatory requirements.
- Respond to incoming provider inquiries received by phone, fax, or portal and route clinical matters to UM Nurses when needed.
- Support daily utilization management activities by prioritizing multiple requests and maintaining consistent turnaround performance.
- Coordinate with internal team members and external providers to clarify missing information and help move cases toward resolution.
Qualifications:
- High school diploma or equivalent required; an associate degree is preferred.
- At least 1 year of experience in healthcare administration, medical office support, managed care, or prior authorization processing.
- Working knowledge of medical terminology and familiarity with ICD-10 and CPT/HCPCS coding concepts.
- Understanding of prior authorization procedures, insurance verification, and healthcare benefit review.
- Strong data entry skills with a high level of accuracy and the ability to manage multiple tasks at once.
- Proficiency with Microsoft Outlook, Word, Excel, and Adobe Acrobat.
- Effective customer service and communication skills when interacting with providers and internal teams.
- Experience with utilization management systems or related healthcare platforms is preferred but not required.