Utilization & Quality Improvement Coordinator

Verda Healthcare Inc; Huntington Beach (CA); On-site; USD 57,308,000 - 71,635,000; Full time

Benefits offered by this job

401(k)

Paid time off

Health insurance

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare, Inc. in Huntington Beach, CA is seeking a detail-oriented UM/QI Coordinator to support daily utilization management, case management, and quality initiatives.

The role requires organizing, documenting, and communicating effectively with providers and facilities to ensure timely care coordination. The coordinator will handle authorizations, medical record retrieval, referrals, and transitions of care, collaborating with UM/CM Supervisors, and the CMO to maintain accurate

Qualifications

• 2 years of experience in managed care with a health plan or IPA.
• Strong verbal and written communication skills.
• Proficiency in Microsoft Word, Excel, and Outlook.

Responsibilities

• Process and coordinate prior authorization, referrals, and inpatient notifications; monitor status and follow up on information.
• Respond to providers, facilities, and IPAs regarding authorization requests and documentation.
• Retrieve, attach, and maintain medical records for authorization and case management.
• Enter and update referral and authorization requests in the system.
• Monitor communications and assist with provider and facility correspondence.
• Conduct member outreach for case management programs to identify care needs and connect to services.
• Support data collection, reporting, and quality improvement initiatives.

Skills

Communication skills

Verbal communication

Education

High school diploma or GED

Tools

Microsoft Word

Excel

Outlook

Job description

Verda Healthcare, Inc. in Huntington Beach, CA is seeking a detail-oriented UM/QI Coordinator to support daily utilization management, case management, and quality initiatives.

The role requires organizing, documenting, and communicating effectively with providers and facilities to ensure timely care coordination. The coordinator will handle authorizations, medical record retrieval, referrals, and transitions of care, collaborating with UM/CM Supervisors, and the CMO to maintain accurate