UM Case Coordinator I: Elevate Member Care Access

PacificSource Health Plans; Charlotte (NC); On-site; USD 36,000 - 57,000; Full time

Job summary

PacificSource Health Plans in Charlotte, NC is seeking an Utilization Management (UM) Coordinator I to support the UM team by researching and coordinating initial and follow-up actions related to clinical documentation and prior authorizations.

This role emphasizes compliance with regulations, collaboration with clinical staff, and excellent member and provider service while navigating multiple systems to keep the member at the center.

Qualifications

• Two years in health insurance or medical setting preferred.
• Experience with CPT/HCPCS/ICD coding preferred.
• Strong written and verbal communication skills.
• Proficient in Microsoft Office and claims software.

Responsibilities

• Validate preauthorization requirements and document UM cases.
• Coordinate inpatient data and ICD coding details.
• Collaborate with clinical staff for UM, CM, and prior auth.
• Provide telephonic service and maintain HIPAA compliance.

Skills

CPT/HCPCS/ICD coding

Microsoft Office

Claims software

Education

High school diploma or equivalent

Associate degree

Medical assistant certification

Certified professional coder

Tools

Microsoft Office

Claims management software

Job description

PacificSource Health Plans in Charlotte, NC is seeking an Utilization Management (UM) Coordinator I to support the UM team by researching and coordinating initial and follow-up actions related to clinical documentation and prior authorizations.

This role emphasizes compliance with regulations, collaboration with clinical staff, and excellent member and provider service while navigating multiple systems to keep the member at the center.