Utilization Management Specialist I

PacificSource Health Plans; Portland (OR); On-site; USD 36,000 - 57,000; Full time

Job summary

PacificSource Health Plans is seeking an Utilization Management Coordinator I to join our team in Oregon. You will coordinate UM cases, validate preauthorization requirements, and document actions while ensuring accuracy and HIPAA compliance.

You will interact with clinicians, members, and providers to facilitate appropriate care and maintain regulatory standards. The role emphasizes teamwork, attention to detail, and the ability to navigate multiple systems to keep the member at the center of

Qualifications

• Proven communication and organizational skills.
• Ability to collaborate with cross-functional teams.
• Knowledge of CPT/HCPCS/ICD coding is a plus.

Responsibilities

• Coordinate and document UM cases in electronic records.
• Validate preauthorization requirements and coding basics.
• Provide high-quality information to members and providers and maintain HIPAA compliance.
• Assist UM leadership and staff to improve workflow and service quality.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Organization

Problem solving

Teamwork

Education

High school diploma or equivalent

Associate degree or medical assisting certification preferred

Job description

PacificSource Health Plans is seeking an Utilization Management Coordinator I to join our team in Oregon. You will coordinate UM cases, validate preauthorization requirements, and document actions while ensuring accuracy and HIPAA compliance.

You will interact with clinicians, members, and providers to facilitate appropriate care and maintain regulatory standards. The role emphasizes teamwork, attention to detail, and the ability to navigate multiple systems to keep the member at the center of