UM Coordinator I: Care Coordination & Utilization

PacificSource Health Plans; United States; Remote; USD 36,000 - 57,000; Full time

Job summary

PacificSource Health Plans is seeking a Utilization Management (UM) Coordinator I to support the UM team by researching and coordinating initial and follow-up clinical documentation and requests. The role emphasizes regulatory compliance, collaboration with clinical staff, and effective member and provider communication, with travel under 5% and a focus on quality, accuracy, and timely decisions.

Minimum two years in health insurance or medical settings, CPT/HCPCS/ICD coding familiarity, and a

Qualifications

• Minimum of two years of experience in health insurance industry or medical setting.
• One year experience working with CPT/HCPCS/ICD coding preferred.
• Other equivalent professional related experience may be considered.

Responsibilities

• Coordinate, create, and document UM cases in the electronic record by validating preauthorization requirements.
• Triage inpatient information and collaborate with UM, CM staff for review.
• Administratively authorize services as directed by UM Leadership.
• Manage a telephonic queue, provide information on prior authorization and referrals, and ensure HIPAA compliance.
• Collaborate with clinical staff to synchronize information for utilization management and care management.
• Identify and initiate corrective steps to resolve workflow issues.

Skills

CPT/HCPCS/ICD coding knowledge

HIPAA compliance understanding

Accountability

Collaboration

Communication

Flexibility

Active listening

Organizational skills

Problem solving

Teamwork

Education

High school diploma or equivalent

Associate degree or medical assistant certification preferred

Tools

Microsoft Office

Medical billing software

Job description

PacificSource Health Plans is seeking a Utilization Management (UM) Coordinator I to support the UM team by researching and coordinating initial and follow-up clinical documentation and requests. The role emphasizes regulatory compliance, collaboration with clinical staff, and effective member and provider communication, with travel under 5% and a focus on quality, accuracy, and timely decisions.

Minimum two years in health insurance or medical settings, CPT/HCPCS/ICD coding familiarity, and a