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Utilization Management Coordinator

SACRAMENTO, CA 95831

Posted: 04/19/2024 Employment Type: Contract to Full Time Industry: Healthcare Job Number: 1678120

Job Description

We are recruiting for a Utilization Management Coordinator (UMC) for an established healthcare organization in Sacramento. The UM Coordinator supports activities related to authorization processing for outpatient, inpatient and ambulatory services. This is a contract to hire opportunity! The ideal candidate has experience with medical referrals, authorizations, health plans and excellent patient customer service. Pay: $18-$21/hour DOE. 


RESPONSIBILITIES:

  • Compile daily inpatient log; review specified UM reports.

  • Process referrals, generate denial letters and perform retro-review coordination. 

  • Acts as liaison to the providers’ offices and the UM/QM staff.  

  • Provide clerical assistance and prepare reports for the UM/QM Supervisor, Manager and/or Director of Medical Management.

  • Answer telephone; screen and direct calls to appropriate staff member or department. 

  • Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely and accurately.

  • Receive and enters appropriate information from referrals.

  • Update, maintain, and notify health plans of inpatient census information on daily basis.

  • Assist with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints.

  • Verify member eligibility by systems inquiry or health plan contact. 

  • Request clinical records per procedure.


QUALIFICATIONS:

  • High School Diploma or GED required. AA degree in related field is preferred.

  • Medical Assistant/Certified preferred.

  • 2+ years utilization management coordination experience is required. Minimum of 3 years’ experience in the medical field is required.

  • Type minimum of 45 WPM.

  • Ability to multi-task, problem solve and analyze data in a fast-paced environment.

  • Demonstrated ability to intervene and diffuse difficult calls. 

  • Proficiency with MS Office applications.

  • Excellent communication skills, both oral and written.

  • Ability to maintain confidentiality and appropriately share information on a need-to-know basis.

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