Remote Utilization Management Specialist

Santa Barbara Cottage Hospital; United States; Remote; USD 30,000 - 33,000; Full time

Job summary

Astrana Health is seeking an Utilization Management Coordinator for a remote role open to CA residents. You will support the UM Program by processing pre-authorizations, retro reviews, and referrals, while ensuring timely submissions meeting health plan standards.

Responsibilities include reviewing daily UM referrals, maintaining provider and plan relationships, and upholding confidentiality. Requires healthcare authorization experience and strong organizational skills.

Qualifications

• High School Graduate; Bachelor’s in Healthcare Administration is a plus
• Experience with authorizations or referrals in healthcare
• A minimum of two years experienced in managed care environment (IPA or MSO preferred)
• Knowledge of medical terminology, CPT, HPCS, ICD-9 codes
• Proficient with Microsoft applications
• 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.
• 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

Skills

Authorizations experience

Managed care experience

Medical terminology knowledge

Microsoft Office proficiency

Organizational skills

Verbal and written communication

Multitasking

Punctuality

Independent work

Team player

Education

High School Diploma

Bachelor's in Healthcare Administration

Tools

Microsoft Office Suite

Job description

Astrana Health is seeking an Utilization Management Coordinator for a remote role open to CA residents. You will support the UM Program by processing pre-authorizations, retro reviews, and referrals, while ensuring timely submissions meeting health plan standards.

Responsibilities include reviewing daily UM referrals, maintaining provider and plan relationships, and upholding confidentiality. Requires healthcare authorization experience and strong organizational skills.