UM Coordinator I: Health Care Authorization & Admin

Community-Health-Center-Network; San Leandro (CA); On-site; USD 32,000 - 45,000; Full time

Job summary

Community Health Center Network (CHCN) in California seeks a UM Coordinator I to provide administrative support for utilization management, process prior authorizations, and ensure HIPAA-compliant handling of PHI. You will communicate with members, providers, and internal teams, helping to streamline referrals and authorizations.

The role requires 1–2 years of health care experience, certification as a Medical Assistant or Pharmacy Technician in CA, and strong organizational skills.

Qualifications

• Must foster a “Can-Do” attitude.
• Detail-oriented with problem-solving abilities.
• Excellent written and verbal communication skills.
• Proficient in CPT/HCPCS and ICD-10 codes.
• Organized and self-managed with the desire to learn.
• Knowledge of English grammar, editing and proofreading.
• Strong organization, time management and multi-tasking.
• Ability to handle detailed work and maintain confidentiality.
• Courteous, patient, and helpful attitude toward colleagues.
• Knowledge of Health Plans/CHCN policies and procedures.
• Minimum of 1–2 years health care experience with medical records, billing, or office work.
• Minimum 1 year experience with State and Federal insurance programs.
• Current Medical Assistant Certification or CA Pharmacy Technician License or equivalent.
• Experience in an HMO/IPA or managed care setting is a plus.
• High school diploma or GED.

Responsibilities

• Research utilization management requests using multiple resources and policies.
• Refer cases to UM Nurses, Case Managers, and Medical Director for clinical review.
• Provide administrative support for utilization and case management activities.
• Answer questions from members/providers on referrals, eligibility, and authorizations.
• Maintain PHI privacy per HIPAA and CHCN policies.
• Make calls to members/providers per UM protocols.
• Coordinate with health plan UM staff and providers.
• Enter prior authorization data in EZ-CAP or relevant database.
• Meet Turn-Around-Time requirements for authorizations and letters.
• Coordinate activities with UM/CM staff and CHCN as a whole.
• Attend required meetings and respond to inquiries from Customer Care.
• Support CHCN Provider Relations on LOA updates with contracted providers.
• Assist with verification of authorization affecting pending/aging claims.
• Provide provider education to clinic staff and hospital facilities.

Skills

Can-Do attitude

Detail-oriented

Communication skills

CPT/HCPCS and ICD-10 knowledge

Organized

English grammar

Time management

Multi-tasking

Confidentiality

Customer service

Policy knowledge

Education

High school diploma or GED

Medical Assistant Certification

California Pharmacy Technician License

Job description

Community Health Center Network (CHCN) in California seeks a UM Coordinator I to provide administrative support for utilization management, process prior authorizations, and ensure HIPAA-compliant handling of PHI. You will communicate with members, providers, and internal teams, helping to streamline referrals and authorizations.

The role requires 1–2 years of health care experience, certification as a Medical Assistant or Pharmacy Technician in CA, and strong organizational skills.