UM Coordinator I - Help Members Access Care

PacificSource Health Plans; United States; Remote; USD 36,000 - 57,000; Full time

Job summary

PacificSource Health Plans is seeking a Utilization Management Coordinator I to support clinical documentation and preauthorization workflows. You will coordinate UM cases, validate CPT/HCPCS/ICD requirements, and document actions in the electronic record with accuracy.

You will collaborate with UM, care management, and provider teams to ensure timely, compliant determinations, while maintaining HIPAA privacy and delivering high-quality member service.

Qualifications

• Knowledge of CPT/HCPCS/ICD terminology and medical coding basics.
• Experience with health insurance or medical settings preferred.
• Strong written and verbal communication in a healthcare context.
• Ability to work independently with minimal supervision.

Responsibilities

• Coordinate, create, and document UM cases in electronic records.
• Validate preauthorization requirements and reference codes.
• Maintain HIPAA compliance and protect member information.
• Manage telephonic queue and provide member/provider education.
• Collaborate with clinical staff to align UM, care management, and prior authorizations.

Skills

Communication

Teamwork

Accountability

Collaboration

Organizational skills

Problem solving

Listening

Education

High school diploma or equivalent

Associate degree

Medical assistant certification

Licensed professional nurse

Certified professional coder cert

Tools

Microsoft Office

Medical/claims management software

Job description

PacificSource Health Plans is seeking a Utilization Management Coordinator I to support clinical documentation and preauthorization workflows. You will coordinate UM cases, validate CPT/HCPCS/ICD requirements, and document actions in the electronic record with accuracy.

You will collaborate with UM, care management, and provider teams to ensure timely, compliant determinations, while maintaining HIPAA privacy and delivering high-quality member service.