Utilization Management Coordinator I (Remote)

PacificSource; Portland (OR); Hybrid; USD 36,000 - 57,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical, vision, and dental insurance

Incentive program

Paid time off and holidays

401(k) plan

Volunteer opportunities

Tuition reimbursement and training

Life insurance

Flexible spending account

Job summary

PacificSource is hiring for a health insurance UM/Care Management-focused role in Portland, OR. The position emphasizes accurate documentation, utilization management, and effective communication with members and providers.

A strong foundation in medical terminology, coding, and insurance practices is essential. The role requires collaboration with clinical staff, handling prior authorizations, referrals, and inpatient data, while upholding HIPAA and quality standards.

Qualifications

• Basic knowledge of medical terminology, procedures, anatomy, diagnoses, care modalities and medical coding.
• Basic understanding of insurance and standard medical billing practices.
• Proficient computer skills with strong written and verbal communication.

Responsibilities

• Coordinate, create, and document UM cases in the electronic record, validating preauthorization requirements.
• Collaborate with clinical staff to synchronize information for utilization management and care management.
• Provide information on prior authorization, referrals, inpatient stays, and benefit utilization; escalate as needed.

Skills

Accountability

Collaboration

Communication

Flexibility

Active listening

Organization

Problem solving

Teamwork

Education

High school diploma or equivalent

Associate degree

Medical assistant certification

Licensed professional nurse

Certified professional coder

Job description

PacificSource is hiring for a health insurance UM/Care Management-focused role in Portland, OR. The position emphasizes accurate documentation, utilization management, and effective communication with members and providers.

A strong foundation in medical terminology, coding, and insurance practices is essential. The role requires collaboration with clinical staff, handling prior authorizations, referrals, and inpatient data, while upholding HIPAA and quality standards.