Utilization Management Coordinator

Our client a respected healthcare organization is seeking a Utilization Management Coordinator. This role plays a key part in supporting care coordination operations through accurate referral processing prior authorization review and timely communication with members and providers. This is a long term temporary opportunity with potential for hire.

The ideal candidate will have at least three years of experience in a medical office with hands-on responsibility for processing referrals and prior authorizations and will demonstrate excellent customer service skills when supporting patients and clinical staff.

• Pay: $27/hour
• Role: 12 month contract
• 100% onsite in Rancho Cordova

Responsibilities

• Process prior authorizations verify eligibility and manage referrals using established criteria.
• Create and update inpatient and referrals including data entry and coordination with liaisons.
• Prepare and distribute referral outcome notifications to members providers and regulatory bodies.
• Track and document appeal and grievances ensuring timely follow up.
• Support UM meetings through scheduling agendas minutes and clerical coordination.
• Monitor admissions/discharges and assist with referral reporting.
• Maintain accurate records and contribute to a positive customer focused work environment.

Skills & Qualifications

• High school diploma or GED required.
• 3 years of experience in a medical environment using computer programs.
• Ability to work independently and collaboratively across multiple teams.
• Strong attention to detail accuracy and data entry skills.
• Experience with insurance processes (preferred).
• Working knowledge of front/back-office operations and ICD 9/scheduling systems (preferred).
• Professional communication skills and ability to maintain confidentiality.
• Ability to use good judgement.
• Must be able to pass a background check and drug screen.