Driving value in healthcare for all.
UM Coordinator
Location
California
Posted
1 day ago
Salary
$19 - $28 / hour
Seniority
Mid Level
Job Description
UM Coordinator
NeueHealth
• 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.
Job Requirements
- High School Diploma or equivalent required; Associate’s degree or healthcare certification preferred.
- 2+ years of experience in health plan environment; experience in utilization management or case management support strongly preferred.
- Capacity To Interpret Health Plan Benefit Decisions.
- Bilingual Preferred (English/ Spanish)
- Certification As A Medical Assistant Preferred.
Benefits
- Health benefits
- Life and disability benefits
- 401(k) savings plan with match
- Paid Time Off
- Paid holidays
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