Utilization Management Coordinator I

Community Health Center Network; San Leandro (CA); On-site; USD 32,000 - 45,000; Full time

Job summary

The Community Health Center Network (CHCN) seeks a UM Coordinator I to provide administrative support, handle prior authorizations, and serve as a resource for members, providers and staff. The role emphasizes accuracy, confidentiality, and timely processing in a health care environment.

Ideal candidates bring strong communication skills, attention to detail, and familiarity with CPT/HCPCS, ICD-10, and state/federal insurance programs, in a regular full-time on-site setting in California.

Qualifications

• Detail-oriented with problem-solving abilities.
• Excellent written and verbal communication skills.
• Proficient in CPT/HCPCS and ICD-10 codes.
• Ability to handle detailed work and maintain confidentiality.
• Minimum 1–2 years health care experience with medical records, medical billing, or medical office.
• Experience with State and Federal insurance programs.
• Current Medical Assistant Certification or California Pharmacy Technician License or equivalent health care experience.
• High school diploma or GED.

Responsibilities

• Research medical utilization management requests using various resources.
• Refer cases to UM Nurses, Case Managers, including the Medical Director for clinical review.
• Provide administrative and clerical support for utilization management and case management activities.
• Answer questions and resolves issues from members and providers about referrals, verification, eligibility, and authorizations.
• Ensure PHI privacy and security in line with HIPAA policies.
• Make calls to members and providers per UM/CM protocols.
• Communicate with health plan UM staff, providers, inpatient staff, and government entities.
• Enter prior authorization data into EZ-CAP or other databases accurately.
• Meet turnaround time requirements for authorizations and letters.
• Draft denial letters per UM Nurses/Medical Director decisions.
• Coordinate activities with UM & CM staff and CHCN.
• Attend required meetings and respond to Customer Care inquiries.
• Coordinate with CHCN Provider Relations on LOA updates and contract negotiations.
• Support claims with verification of authorization status.
• Provide provider education to CHCN staff and escalation to UM Supervisor when needed.
• Maintain regular attendance and knowledge of CHCN lines of business.
• Adhere to compliance requirements regarding turnaround times.

Skills

Communication skills

Detail oriented

Problem solving

Education

High School Diploma or GED

Medical Assistant Certification or Pharmacy Technician License

Job description

The Community Health Center Network (CHCN) seeks a UM Coordinator I to provide administrative support, handle prior authorizations, and serve as a resource for members, providers and staff. The role emphasizes accuracy, confidentiality, and timely processing in a health care environment.

Ideal candidates bring strong communication skills, attention to detail, and familiarity with CPT/HCPCS, ICD-10, and state/federal insurance programs, in a regular full-time on-site setting in California.