UM Coordinator I: Help Members Access Quality Care

PacificSource Health Plans; Raleigh (NC); On-site; USD 36,000 - 57,000; Full time

Job summary

PacificSource Health Plans in Raleigh, NC is seeking a Utilization Management Coordinator I to support UM processes for members and providers. You will validate preauthorization requirements, document cases, and collaborate with clinical staff while maintaining HIPAA compliance.

The role emphasizes accuracy, critical thinking, and strong communication in a regulatory, fast-paced health insurance environment. Prior CPT/HCPCS/ICD coding knowledge is a plus.

Qualifications

• Minimum of two years of experience in health insurance industry or medical setting.
• One year experience working with CPT/HCPCS/ICD coding preferred.
• Other equivalent professional related experience may be considered.

Responsibilities

• Adhere to dependability, member and provider focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all functions.
• Coordinate, create, and document UM cases in the electronic record by validating preauthorization requirements, utilizing a basic understanding of ICD, CPT and HCPCS codes, and including plan types, member benefits, eligibility, limitations, exclusions, and claims history.

Skills

Communication

Teamwork

Problem Solving

Organization

Customer service

Education

High school diploma or equivalent

Associate degree or medical assistant certification

Nurse license or certified coding certification preferred

Job description

PacificSource Health Plans in Raleigh, NC is seeking a Utilization Management Coordinator I to support UM processes for members and providers. You will validate preauthorization requirements, document cases, and collaborate with clinical staff while maintaining HIPAA compliance.

The role emphasizes accuracy, critical thinking, and strong communication in a regulatory, fast-paced health insurance environment. Prior CPT/HCPCS/ICD coding knowledge is a plus.