Utilization Management Coordinator - Remote

Astrana Health Management; Orange, Northern (CA, KY); Hybrid; USD 30,000 - 33,000; Full time

Job summary

Astrana Health is seeking a Remote Utilization Management Coordinator in California to support clinical, management, and client activities within the UM program. You will handle pre-authorizations, retro reviews, and health plan contracts while ensuring timely, compliant referrals and maintaining confidentiality.

The role requires two years in managed care, knowledge of medical terminology, and strong organizational and communication skills.

Qualifications

• High School Graduate; Bachelor's in Healthcare Administration is a plus.
• Experience with authorizations or referrals in healthcare.
• Minimum of two years in a managed care environment (IPA or MSO preferred).
• Knowledge of medical terminology; including CPT, ICD-9 codes.
• Proficient with Microsoft applications.
• Good organizational skills; verbal and written communication.
• Ability to multitask and problem solve in a fast-paced environment.
• Punctual and detail-oriented.
• Ability to follow directions and work independently per department standards.
• Strong teamwork and attendance record.

Responsibilities

• Comply with UM policies and procedures; annual review of selected UM policies.
• Read and understand NMM UM Customer Service Policy and Procedures.
• Process routine and urgent treatment authorization requests according to policy.
• Attach incoming notes to appropriate authorizations.
• Move referrals back from eligibility/benefits to the correct review queue.
• Review and process daily assigned UM referrals (avg 150-250) per TAP guidelines.
• Verify benefits, eligibility, provider status, contracted vs non-contracted.
• Contact providers for clarification or notes as needed.
• Verify facilities are contracted or CMS approved when required.
• Attend provider and interdepartmental calls with strong customer service.
• Report daily activities or problems to UM Lead 3.
• Maintain confidentiality and relationships with health plans and medical directors.
• Assist team to meet turnaround times.

Skills

Authorizations experience

Managed care

Medical terminology

MS Office

Organizational skills

Communication skills

Multitasking

Punctuality

Team player

Attendance

Education

High School Graduate

Bachelor's in Healthcare Administration

Job description

Utilization Management Coordinator - Remote

Department: HS - UM

Employment Type: Full Time

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Reporting To: Michelea Stanford

Compensation: $22.00 - $24.00 / hour

Description

The Utilization Management Coordinator is responsible for supporting clinical, management, and client activities, comprising the UM Program. The Utilization Management Coordinator understands all UM processes such as pre-authorizations, retro reviews, Division of Financial Responsibilities and Health Plan contracts. The UM Coordinator will ensure we are processing quality referrals in a timely manner meeting the health plan standards.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Comply with UM policies and procedures. Annual review of selected UM policies.
• Read and understand NMM UM Customer Service Policy and Procedures
• Process Routine & Urgent treatment authorization requests according to the NMM Policy & Procedure Manual based on UM Level 1 review process.
• Assist with attaching incoming notes to appropriate authorizations
• Move referrals coming back from eligibility and or benefits to the correct queue for review
• Accurately review, screen and process daily assigned UM referrals (avg 150-250) in accordance with IPA and health plan TAT guidelines
• Responsible for verification to include but not limited to: benefit matrix through DOFR, eligibility, provider status (contracted/non-contracted), carved out and others.
• Contact providers office as needed for clarification, notes or redirections
• Verify that facilities are contracted and or a CMS approved facility when required.
• Attend to provider and interdepartmental calls in accordance with exceptional customer service
• Reports to UM Lead 3 on activities or problems occurring throughout the day.
• Maintains strictest confidentiality at all times.
• Maintain good relationships with health plans and medical directors and external contacts.
• Team skills, assist others as needed in order to comply with TAT.
• Other duties as assigned

Qualifications

• High School Graduate, Bachelor's in Healthcare Administration is a plus
• Experience with authorizations or referrals in healthcare
• A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred
• Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
• Proficient with Microsoft applications
• Good organizational skills, verbal and written communication skills
• Ability to multitask and problem solve in a fast pace work environment
• Punctuality and detail-oriented
• Ability to follow directions and perform work independently according to department standards
• Must be a strong team player and have excellent attendance record

Environmental Job Requirements and Working Conditions

• This is a remote position. Candidates must reside in California.
• This position will typically work Monday - Friday from 8:00 am to 5:00 pm. There may be up to 1 hour of voluntary OT per day.
• The target pay range for this role is $22.00 - $24.00 per hour. This salary range represents our national target range for this role

Astrana Health is proud to be an Equal Employment Opportunity and Aff…? We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [e-mail] to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.