Utilization Management Coordinator (Remote)

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

Benefits offered by this job

Flexible telecommute policy

Medical, vision, and dental insurance

401(k) plan

Paid time off and holidays

Tuition reimbursement and training

Life insurance

Job summary

PacificSource is seeking a Utilization Management professional to coordinate UM cases, validate preauthorization requirements, and document activities in electronic records. You will assess inpatient data, work with clinical staff, and ensure compliance with HIPAA and regulatory standards.

The role requires a minimum of two years in health insurance or medical settings and familiarity with CPT/HCPCS/ICD coding, with strong communication and organizational skills. Some travel may be required.

Qualifications

• Two years of experience in health insurance industry or medical setting required.
• Basic understanding of CPT/HCPCS/ICD coding preferred.
• Strong written and verbal communication skills; ability to work independently and as part of a team.

Responsibilities

• Coordinate, create, and document UM cases in electronic records, validating preauthorization requirements.
• Assess accuracy of daily inpatient information and compile inpatient data.
• Collaborate with clinical staff on utilization management, care management, prior authorization, and inpatient stay processes.

Skills

CPT/HCPCS/ICD coding

Communication (written/verbal)

Problem solving

Teamwork

Education

High school diploma or equivalent

Associate degree or medical certifications (e.g., medical assistant, licensed practical nurse, CPC)

Job description

PacificSource is seeking a Utilization Management professional to coordinate UM cases, validate preauthorization requirements, and document activities in electronic records. You will assess inpatient data, work with clinical staff, and ensure compliance with HIPAA and regulatory standards.

The role requires a minimum of two years in health insurance or medical settings and familiarity with CPT/HCPCS/ICD coding, with strong communication and organizational skills. Some travel may be required.