UM Coordinator 2

Become a part of our caring community and help us put health first
 The UM (Utilization Management) Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

As a UM (Utilization Management) Coordinator 2 you will be responsible for taking prior authorization requests from providers and members. Because of this we are a fast paced metric driven environment where you are sitting at a desk all day taking about 30-50 calls from providers. In the future this could lead to opportunities assisting on member calls.

You will assist providers with determining whether the service they will be providing to a member requires authorization or referral. If a member needs a medical service, their provider would call us to start the authorization process to determine if it meets medical necessity for that service. The purpose is to ensure providers are not requesting unnecessary services for members, which lead to out of pocket expenses for those members. You may also be assisting providers with updates or questions on those authorizations/referrals. 

The authorization process starts with our team. You may also assist our members with authorization requests and this may require outbound calls to providers offices. As a UM coordinator you will be collecting clinical information and reviewing resources and data to determine positive outcomes for our consumers. You will be challenged on a daily basis as our processes and procedures tend to change due to CMS rules and regulations. Taking pride in your work will be key as we have strong quality requirements that need to be met on a monthly basis. Our mission is health teammates healthy company and health customers. We focus on living out our values on a daily basis by creating an environment where you feel valued, respected and treated with kindness. We work and learn together creating the best solutions for the people we serve. We are committed to fulfilling our purpose by delivering on our commitments to serve our customers with excellence.

This position requires the use of multiple systems, therefore the ability to maneuver multiple systems at one time is vital. 

In this role you will:

• Take inbound calls to engage members and/or providers to verify clinical information
• Handle customer inquiries both telephonically and by fax
• Provide excellence customer service to our customers
• Document all …