Utilization Management (UM) Coordinator
New
N
NeueHealthHealthcare
Location: California, United StatesFull-TimeMiddle
Salary19.27 - 28.91 USD per hour
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Job Details
- Languages
- Spanish
- Experience
- 2+ years of experience in health plan environment
- Required Skills
- Microsoft Office
Requirements
- High School Diploma or equivalent required; Associate’s degree preferred.
- 2+ years of experience in health plan environment.
- Experience in utilization management or case management support strongly preferred.
- Certification as a Medical Assistant preferred.
- Strong knowledge of medical terminology and healthcare authorization processes.
- Proficient in Microsoft Office Suite and medical management systems (e.g., MCG).
- Excellent communication, organization, and customer service skills.
- Ability to work independently and manage multiple priorities.
Responsibilities
- Receive, review, and process incoming requests for authorization of medical services.
- Coordinate with providers, members, and internal clinical staff to gather necessary documentation for utilization reviews.
- Enter authorization requests and updates into the utilization management system accurately and promptly.
- Track and monitor pending authorizations to ensure timely processing and communication of decisions.
- Collaborate with nurses and physicians to facilitate medical necessity reviews and ensure compliance with clinical guidelines.
- Provide notification of determination (approvals or denials) to providers and members in accordance with regulatory timeframes.
- Maintain accurate and organized records to ensure compliance with accreditation and regulatory bodies (e.g., NCQA, CMS, Health Plans).
- Assist in audits and quality improvement activities as needed.
- Serve as a liaison between internal departments, providers, and external vendors.
- Ensure compliance with HIPAA and confidentiality standards at all times.
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