UM Coordinator I: Care Utilization & Authorization

PacificSource; Portland (OR); On-site; USD 36,000 - 57,000; Full time

Job summary

PacificSource is seeking an Utilization Management (UM) Coordinator I to support the UM team by researching and coordinating clinical documentation and requests. The role emphasizes accuracy, compliance with federal and state regulations, and collaboration with clinicians to improve member care.

The position requires minimum two years in health insurance or medical settings, familiarity with CPT/HCPCS/ICD coding, and strong communication skills.

Qualifications

• Minimum of two years of experience in health insurance industry or medical setting.
• Experience with CPT/HCPCS/ICD coding preferred.
• Knowledge of medical terminology, procedures, anatomy, diagnoses, and care modalities.
• Understanding of insurance, billing practices, and HIPAA/privacy regulations.
• Strong written and verbal communication skills and attention to detail.
• Ability to work independently with minimal supervision.

Responsibilities

• Coordinate, create, and document UM cases in the electronic record.
• Validate preauthorization requirements and coding details (ICD, CPT, HCPCS).
• Assess inpatient data accuracy and compile inpatient events with diagnoses.
• Collaborate with clinical staff for utilization management and care coordination.
• Document status of reviews and update medical records accordingly.
• Provide education and assist members and providers with prior authorization.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Planning & Organization

Problem Solving

Teamwork

Education

High school diploma or equivalent

Associate degree

Medical assistant certification

Licensed professional nurse

Certified professional coder

Tools

Microsoft Office

Job description

PacificSource is seeking an Utilization Management (UM) Coordinator I to support the UM team by researching and coordinating clinical documentation and requests. The role emphasizes accuracy, compliance with federal and state regulations, and collaboration with clinicians to improve member care.

The position requires minimum two years in health insurance or medical settings, familiarity with CPT/HCPCS/ICD coding, and strong communication skills.