UM Coordinator - Hybrid
About The Position
Astrana Health is seeking a dedicated Utilization Management (UM) Coordinator to support the UM department in reviewing, monitoring, and processing prior authorization requests while ensuring compliance with regulatory standards and health plan guidelines. The UM Coordinator will serve as a key liaison between providers, members, and internal clinical staff, delivering excellent customer service and ensuring accurate documentation and timely processing of referrals. This role is responsible for coordinating and documenting medical review activities to confirm that services meet established criteria for medical necessity, appropriateness, and efficiency, while facilitating clear and timely communication across all stakeholders. We are seeking candidates who have experience with referral or authorization coordination! Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team
Requirements
- High School Graduate, Bachelor's in Healthcare Administration is a plus
- A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred
- Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
- Proficient with Microsoft applications, EZCAP preferred
- Good organizational skills, verbal and written communication skills
- Ability to multitask and problem solve in a fast pace work environment
- Punctuality and detail-oriented
- Ability to follow directions and perform work independently according to department standards
- Must be a strong team player and have excellent attendance record
Responsibilities
- Comply with UM policies and procedures. Annual review of selected UM policies.
- Read and understand NMM UM Customer Service Policy and Procedures
- Process Routine & Urgent treatment authorization requests according to the NMM Policy & Procedure Manual based on UM Level 1 review process.
- Assist with attaching incoming notes to appropriate authorizations
- Move referrals coming back from eligibility and or benefits to the correct queue for review
- Accurately review, screen and process daily assigned UM referrals (avg 150-250) in accordance with IPA and health plan TAT guidelines
- Responsible for verification to include but not limited to: benefit matrix through DOFR, eligibility, provider status (contracted/non-contracted), carved out and others.
- Contact providers office as needed for clarification, notes or redirections
- Verify that facilities are contracted and or a CMS approved facility when required.
- Attend to provider and interdepartmental calls in accordance with exceptional customer service
- Reports to UM Lead 3 on activities or problems occurring throughout the day.
- Maintains strictest confidentiality at all times.
- Maintain good relationships with health plans and medical directors and external contacts.
- Team skills, assist others as needed in order to comply with TAT.
- Other duties as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
