UM Intake Specialist

Lucent Health Solutions LLC; Nashville (TN); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Unlimited PTO

10 Paid Holidays

Medical, Dental, Vision benefits

Job summary

Lucent Health is seeking an UM Admin Support Specialist to provide admin and operational support to the Utilization Management team. You will handle intake, processing, and tracking of prior authorization, referrals, and case reviews, coordinating with members, providers, and clinical reviewers to ensure timely, compliant UM operations.

Ideal candidates have healthcare admin experience, familiar with HIPAA, and strong organization in fast-paced settings.

Qualifications

• 2+ years of experience in a healthcare administrative role.
• Working knowledge of prior authorization and referral processes.
• Proficiency with UM/case management software and Microsoft Office.
• Strong organizational skills with multitasking ability.
• Excellent written and verbal communication and PHI confidentiality.

Responsibilities

• Receive, log, and triage prior authorization, referral, and concurrent review requests.
• Data entry and case setup in the UM platform with eligibility checks.
• Route cases to nurse reviewers or medical directors based on urgency and workflow.
• Prepare and track correspondence including approval letters and denials.
• Coordinate peer-to-peer reviews, appeals, and internal case conferences.

Skills

Healthcare Admin

Prior Authorization

Case Management

Medical Terminology

Microsoft Office

Education

High school diploma

Associate's degree in healthcare administration

Tools

UM software

Job description

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.

Summary

The UM Admin Support Specialist provides essential administrative and operational support to the Utilization Management team, ensuring timely and accurate intake, processing, and tracking of prior authorization, referral, and case review requests. This role serves as a key point of coordination between members, providers, and clinical reviewers — managing correspondence, scheduling, data entry, and reporting to keep UM operations running smoothly and in compliance with regulatory and accreditation standards. The ideal candidate brings prior experience in healthcare or health plan administration and is comfortable juggling multiple queues, deadlines, and stakeholders in a fast-paced environment.

Responsibilities

• Receive, log, and triage incoming prior authorization, referral, and concurrent review requests from providers, members, and internal systems (fax, portal, EDI).
• Perform accurate data entry and case setup in the UM platform, verifying member eligibility, provider information, and requested services prior to clinical review.
• Route cases to the appropriate nurse reviewer, medical director, or delegate based on urgency, service type, and established workflows; monitor turnaround-time (TAT) clocks to ensure regulatory deadlines are met.
• Prepare, send, and track written correspondence to members and providers, including approval letters, denial notifications, and requests for additional clinical information.
• May assist with scheduling peer-to-peer reviews, appeals, and internal case conferences; coordinate calendars across nurses, medical directors, and external providers.
• Handle outgoing auto-authorization faxes, ensuring timely processing and accurate routing to external providers.
• Manage escalations and case query emails, ensuring timely response and appropriate routing to clinical or leadership staff as needed.
• Respond to provider and member inquiries regarding case status, required documentation, and next steps, escalating clinical questions to licensed staff as appropriate.
• Identify and flag process bottlenecks or recurring errors and support continuous improvement of UM administrative workflows.
• Assist with special projects, audits, and accreditation preparation as assigned.
• Other duties as assigned consistent with the scope, level and general responsibilities of this position.

Required Qualifications

• High school diploma or equivalent required; Associate's degree in healthcare administration or related field preferred.
• 2+ years of experience in a healthcare administrative role, preferably within utilization management, case management, or a health plan/payer setting.
• Working knowledge of prior authorization and referral processes, medical terminology, and basic ICD-10/CPT coding concepts.
• Proficiency with UM/case management software platforms and Microsoft Office (Outlook, Excel, Word).
• Strong organizational skills with the ability to manage multiple queues and deadlines simultaneously.
• Excellent written and verbal communication skills, with a professional and service-oriented approach to providers and members.
• Understanding of HIPAA privacy requirements and commitment to maintaining confidentiality of protected health information (PHI).

Preferred Qualifications

• Experience supporting URAC- or NCQA-accredited UM programs.
• Familiarity with stop-loss, self-funded, or TPA administrative environments.
• Experience generating and interpreting operational reports and dashboards.

What We Provide

• Unlimited Paid Time Off
• 10 Paid Holidays
• Medical, Dental, Vision, and other ancillary benefits

Company Culture

At Lucent Health, our success is built on employees who are honest, ethical and hardworking. We communicate transparently, act with integrity, and hold ourselves accountable for our work and decisions. We treat colleagues, clients and partners with fairness, respect and confidentiality. And we bring consistency, initiative and adaptability to everything we do, taking ownership of challenges and going the extra mile when it counts.

Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.