Utilization Management Coordinator I — Remote

PacificSource; Springfield (OR); On-site; USD 36,000 - 57,000; Full time

Benefits offered by this job

Telecommute policy

Medical insurance

Vision insurance

Dental insurance

401(k) plan

Paid time off

Holidays

Life insurance

Tuition reimbursement

Training

Job summary

PacificSource seeks an experienced professional in Oregon to support utilization management processes. The role involves coordinating UM cases, validating preauthorizations, and documenting patient data across electronic records while ensuring accuracy and compliance.

The ideal candidate has at least two years in health insurance or medical settings, with knowledge of CPT/HCPCS/ICD coding and strong communication skills to assist members and providers.

Qualifications

• Two years of health insurance industry or medical setting experience required.
• Basic understanding of CPT/HCPCS/ICD coding and related terminology.

Responsibilities

• Adhere to dependability, member and provider focus, and performance standards.
• Coordinate, document UM cases and validate preauthorization requirements.
• Collaborate with clinical staff for utilization and care management.
• Interface with members and providers regarding benefits and referrals.
• Maintain HIPAA-compliant documentation across systems.

Skills

Customer service

Telephone communication

Problem solving

Critical thinking

Education

High school diploma or equivalent

Associate degree preferred

Tools

Medical billing software

ICD CPT HCPCS knowledge

Job description

PacificSource seeks an experienced professional in Oregon to support utilization management processes. The role involves coordinating UM cases, validating preauthorizations, and documenting patient data across electronic records while ensuring accuracy and compliance.

The ideal candidate has at least two years in health insurance or medical settings, with knowledge of CPT/HCPCS/ICD coding and strong communication skills to assist members and providers.