UM Care Coordinator

All Care To You; Orange (CA); Hybrid; USD 42,000 - 62,000; Full time

Job summary

All Care To You is seeking a Care Coordinator to support the care management team in day-to-day operations. You will collaborate with Utilization Management Nurses to process referrals, ensure eligibility and benefits coverage, and maintain accurate records while adhering to HIPAA guidelines.

The role requires strong communication, multitasking, and confidentiality in a fast-paced environment. Proficiency with MS Office, Outlook, and collaboration tools is essential, with flexible work-from-home

Qualifications

• 2 years healthcare administration experience.
• 3 years customer service experience.
• HMO/Medical Group experience preferred.
• Must be able to work 8 - 5 PM Pacific Standard Time.
• Bilingual proficiency preferred.
• Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe.
• Strong ability to multi-task and work in a fast-paced environment.
• Strong ability in problem-solving.
• Ability to work in an extremely confidential environment.
• Strong written and verbal communication skills.
• Technology savvy and highly organized.

Responsibilities

• Assists and monitors with the processing of authorization requests.
• Documents, updates and finalizes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-10 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all referrals are processed within the designated timeframe.
• Looks up information in the DOFR and EOC as needed.
• Follows Coordinator guidelines for authorization requests.
• Coordinates, identifies, and routes referrals that require review to Utilization Management Nurses as appropriate.
• Assist with data entry, updates, and corrections per the requested time frame.
• Interacts with UM nurses to assist them with requests and provides timely follow through.
• Takes incoming calls for the department.
• Calls providers, members, and/or health plans.
• Maintain PHI and compliance with HIPAA; Proactively takes action to solve problems.
• Attends meetings as requested.
• Completes required training.
• Other duties as needed.

Skills

Healthcare admin

Customer service

Bilingual

Outlook

Microsoft Teams

Zoom

Microsoft Word

Excel

Adobe

Tools

Outlook

Microsoft Teams

Zoom

Microsoft Word

Excel

Adobe

Job description

About Us

All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services toIndependent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. We offer a flexible work environment and schedules with work from home options. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available.

Job purpose

The Care Coordinator is responsible for supporting the care management team. The Coordinator will work directly with the Utilization Management Nurse(s) in day-to-day operations. This position is ideal for someone who is a strong communicator and team player.

Duties and responsibilities

• Assists and monitors with the processing of authorization requests.
• Documents, updates and finalizes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-10 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all referrals are processed within the designated timeframe.
• Looks up information in the DOFR and EOC as needed.
• Follows Coordinator guidelines for authorization requests.
• Coordinates, identifies, and routes referrals that require review to Utilization Management Nurses as appropriate.
• Assist with data entry, updates, and corrections per the requested time frame.
• Interacts with UM nurses to assist them with requests and provides timely follow through.
• Takes incoming calls for the department.
• Calls providers, members, and/or health plans.
• Maintain PHI and compliance with the Health Insurance Portability and Accountability Act (HIPAA)Proactively takes action to solve problems.
• Attends meetings as requested.
• Completes required training.
• Other duties as needed.

Qualifications

• 2 years healthcare administration experience
• 3 years customer service experience
• HMO/Medical Group experience preferred
• Must be able to work 8 - 5 PM Pacific Standard Time.
• Bilingual proficiency preferred
• Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe
• Strong ability to multi-task and work in a fast-paced environment
• Strong ability in problem-solving
• Ability to work in an extremely confidential environment
• Strong written and verbal communication skills
• Technology savvy and highly organized