Utilization Management (UM) Coordinator (Inpatient)

Alignment Health; Northern (KY); Hybrid; USD 41,000 - 62,000; Full time

Job summary

Alignment Health is seeking an organized inpatient utilization management coordinator to help manage census, admissions, and discharge planning for seniors. You will gather medical records, process authorizations, and work with CM leadership to ensure efficient patient flow.

The role requires knowledge of ICD-10/CPT, Medicare Advantage, and medical terminology, with a focus on accurate documentation and timely communication within a supportive UM team.

Qualifications

• Inpatient concurrent review experience; census and admission management.
• Experience with Medicare Advantage and hospital admissions.
• Knowledge of ICD-10 and CPT codes; medical terminology.
• Proficient with Microsoft Office; typing ~50 WPM.
• Access Express/Portal and Epic experience preferred.

Responsibilities

• Assist with daily census by entering face sheets for hospitals and SNFs.
• Obtain and attach medical records to authorizations.
• Enter referral requests and authorizations in the system with ICD-10/CPT.
• Monitor fax folders; complete tasks per nurse supervision.
• Maintain facility records and support discharge planning.
• Communicate with CM team and attend case management meetings.
• Maintain confidentiality and ensure timely responses.

Skills

Census management

Medical records

Authorizations

ICD-10 CPT codes

Medicare Advantage

Epic

Access Express/Portal

Microsoft Office

Typing 50 WPM

Medical terminology

Education

High school diploma

GED accepted

Medical Terminology Certificate

Tools

Epic

Access Express

Portal

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Alignment Health is seeking an organized, detail-oriented and customer service oriented inpatient utilization management (UM) coordinator to join the UM team. As an inpatient UM coordinator, you will assist with managing census and admissions, retrieve medical records, and discharge planning while working with the case management (CM) supervisor, manager, and director of healthcare services. If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors – we’re looking for you!

GENERAL DUTIES / RESPONSIBILITIES:

• Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF).
• Obtain medical records from hospitals and SNF’s.
• Attach medical records to authorizations.
• Enter referral requests / authorizations in system using ICD 10 and CPT coding.
• Monitor fax folders.
• Complete and document tasks as assigned by nurse.
• Maintain documentation on facilities contacted.
• Assist with maintaining and updating member’s records.
• Assist with mailing or faxing correspondence to facilities, related to, as needed.
• Request medical records from facilities, etc., related to members activities, as needed.
• Attend case management presentations and participates, as appropriate.
• Recognize work-related problems and contributes to solutions.
• Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
• Maintain confidentiality of information between and among health care professionals.
• Be a positive team player.

Job Requirements:

• Inpatient concurrent review experience Experience with census and admission management Experience in discharge planning Experience entering referrals and prior authorizations.
• Experience with Medicare Advantage
• Experience with hospital and / or facilities backend admissions
• Knowledge of medical terminology
• Knowledge of ICD10 and CPT codes
• Knowledge of Medicare, HMO, MMO, managed care plans
• Computer proficient
• Medical assistant experience preferred Knowledge working in Access Express / Portal, Epic preferred.

Education:

• High school diploma or general education degree (GED) or (4) years' additional experience in lieu of education.
• Medical Terminology Certificate preferred.

Specialized Skills:

• Proficient in Microsoft Office (Outlook, Excel, Word) Able to type minimum 50 words-per-minute (WPM).
• Organized and detail oriented.
• File systematically.
• Good interpersonal skills.
• Strong written, verbal, and telephonic communication skills Able to read, write, and speak English fluently.

Licensure:

Required: None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

1. While performing the duties of this job, the employee is regularly required to talk or hear.
2. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
3. The employee frequently lifts and / or moves up to 10 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range:

Pay Range: $41,472.00 - $62,208.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

Alignment Health is championing a new path in senior care that empowers members to age well and live their most vibrant lives. Our mission-focused team makes high-quality, low-cost care a reality for members every day. Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who are in need. We believe that great work comes from people who are inspired to be their best. We've built a team of people who want to make a difference in the lives of the seniors we serve. Come join the team that is changing health care - one person at a time.