UM Coordinator I: Health Care Utilization Specialist

PacificSource; Boise (ID); On-site; USD 42,000 - 62,000; Full time

Job summary

PacificSource is seeking an Utilization Management Coordinator I to join our team. You will research and coordinate initial and follow-up clinical documentation, ensure regulatory compliance, and support UM processes with accuracy in the electronic record.

You will collaborate with clinical staff, assist in prior authorizations, and help maintain a high standard of member and provider relations, all while protecting HIPAA privacy and delivering quality service.

Qualifications

• Minimum of two years of experience in health insurance or medical setting.
• Basic understanding of CPT/HCPCS/ICD coding.
• Knowledge of medical terminology, procedures, anatomy, and care modalities.

Responsibilities

• Research and coordinate initial and follow-up clinical documentation for UM requests.
• Adhere to regulatory requirements and maintain HIPAA compliance in all handling of records.
• Coordinate UM cases, validate preauthorization requirements, and document in the electronic record.
• Collaborate with clinical staff to synchronize information for UM and care management.
• Administer services as directed by UM leadership and manage calls with sensitivity and professionalism.

Skills

Customer service

HIPAA compliance

Medical terminology

Problem solving

Communication

Education

High school diploma

Associate degree preferred

Medical assistant certification preferred

Licensed practical nurse / registered nurse preferred

Certified professional coder preferred

Job description

PacificSource is seeking an Utilization Management Coordinator I to join our team. You will research and coordinate initial and follow-up clinical documentation, ensure regulatory compliance, and support UM processes with accuracy in the electronic record.

You will collaborate with clinical staff, assist in prior authorizations, and help maintain a high standard of member and provider relations, all while protecting HIPAA privacy and delivering quality service.