UM Coordinator I: Facilitate Access to Quality Care

PacificSource Health Plans; Bend (OR); Presencial; USD 36.000 - 57.000; Jornada completa

Descripción de la vacante

PacificSource Health Plans in Bend, Oregon, is seeking a Utilization Management (UM) Coordinator I to support clinical documentation and preauthorization workflows. You will validate requirements, document UM cases, and collaborate with UM/CM staff to ensure accurate and timely decisions that support member care.

Ideal candidates have 2+ years in health insurance or medical settings, familiarity with CPT/HCPCS/ICD coding, and strong communication skills to liaise with providers, members, and

Formación

• Minimum 2 years in health insurance or medical setting required.
• 1 year experience with CPT/HCPCS/ICD coding preferred.
• Ability to follow regulatory requirements and HIPAA.

Responsabilidades

• Coordinate, create, and document UM cases in the electronic record.
• Validate preauthorization requirements and coding basics (ICD, CPT, HCPCS).
• Triage and manage telephonic inquiries with HIPAA compliance.
• Collaborate with clinical staff to synchronize UM processes and care management.
• Authorize services administratively as directed by UM Leadership.
• Maintain up-to-date reference documents, policies and procedures.

Conocimientos

Accountability

Collaboration

Communication (written/verbal)

Problem Solving

Teamwork

Organizational skills

Educación

High School Diploma or Equivalent

Medical Assistant Certification / Coding Certification (preferred)

Herramientas

Microsoft Office

Medical billing software

Claims management software

Descripción del empleo

PacificSource Health Plans in Bend, Oregon, is seeking a Utilization Management (UM) Coordinator I to support clinical documentation and preauthorization workflows. You will validate requirements, document UM cases, and collaborate with UM/CM staff to ensure accurate and timely decisions that support member care.

Ideal candidates have 2+ years in health insurance or medical settings, familiarity with CPT/HCPCS/ICD coding, and strong communication skills to liaise with providers, members, and