UM Coordinator I — Healthcare Utilization & Member Care

PacificSource Health Plans; Boise (ID); Vor Ort; USD 36.000 - 57.000; Vollzeit

Zusammenfassung

PacificSource Health Plans seeks a Utilization Management Coordinator I to support the UM team by researching and coordinating initial and follow-up actions related to clinical documentation and requests. The role emphasizes accuracy, HIPAA compliance, and collaboration with care teams to ensure appropriate member care.

Minimum two years in health insurance or medical settings is required; CPT/HCPCS/ICD coding knowledge is preferred.

Qualifikationen

• Minimum two years of experience in health insurance or medical setting.
• Basic knowledge of CPT/HCPCS/ICD coding.

Aufgaben

• Coordinate, create, and document UM cases in the electronic record, validating preauthorization needs and including plan details.
• Assess daily inpatient information from external systems and facilities, compile data, and triage for review by UM/CM staff.
• Collaborate with clinical staff to synchronize information for utilization management, care management, and prior authorization.
• Administratively authorize services as directed by UM Leadership.
• Manage an active telephonic queue with HIPAA-compliant information delivery and referrals guidance.
• Work across multiple systems using critical thinking to keep the member at the center.
• Identify and update reference documents, policies, and procedures as needed.
• Attend cross-functional meetings to educate others on UM functions and assist member care.

Kenntnisse

Accountability

Collaboration

Communication

Flexibility

Organizational skills

Problem solving

Teamwork

Ausbildung

High school diploma or equivalent

Associate degree

Medical assistant certification

Nurse license or professional coding certification

Tools

Microsoft Office

Medical software/claims management

Jobbeschreibung

PacificSource Health Plans seeks a Utilization Management Coordinator I to support the UM team by researching and coordinating initial and follow-up actions related to clinical documentation and requests. The role emphasizes accuracy, HIPAA compliance, and collaboration with care teams to ensure appropriate member care.

Minimum two years in health insurance or medical settings is required; CPT/HCPCS/ICD coding knowledge is preferred.