Centrum Health · 1 day ago
UM Coordinator
California, United States
Full-time
Onsite
Entry Level
$19.27/hr - $28.91/hr
2+ years expNeueHealth is a value-driven healthcare company committed to transforming healthcare and creating a better care experience for all. The Utilization Management Coordinator supports the coordination and administrative functions of the utilization review process, ensuring timely and appropriate review of healthcare services in accordance with established guidelines and regulatory requirements.
DentalHealth CareHospitalMedicalPrimary and Urgent Care
Responsibilities
Receive, review, and process incoming requests for authorization of medical services
Coordinate with providers, members, and internal clinical staff to gather necessary documentation for utilization reviews
Enter authorization requests and updates into the utilization management system accurately and promptly
Track and monitor pending authorizations to ensure timely processing and communication of decisions
Collaborate with nurses and physicians to facilitate medical necessity reviews and ensure compliance with clinical guidelines
Provide notification of determination (approvals or denials) to providers and members in accordance with regulatory timeframes
Maintain accurate and organized records to ensure compliance with accreditation and regulatory bodies (e.g., NCQA, CMS, Health Plans)
Assist in audits and quality improvement activities as needed
Serve as a liaison between internal departments, providers, and external vendors
Ensure compliance with HIPAA and confidentiality standards at all times
Qualification
Required
High School Diploma or equivalent required
2+ years of experience in health plan environment
Capacity To Interpret Health Plan Benefit Decisions
Bilingual Required (English/ Spanish)
Strong knowledge of medical terminology and healthcare authorization processes
Proficient in Microsoft Office Suite and medical management systems (e.g., , MCG, or similar UM platforms)
Excellent communication, organization, and customer service skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Preferred
Associate's degree or healthcare certification preferred
Experience in utilization management or case management support strongly preferred
Certification As A Medical Assistant Preferred
Benefits
Health benefits
Life and disability benefits
A 401(k) savings plan with match
Paid Time Off
Paid holidays
Company
Centrum Health
Centrum Health provides medical, primary care, dental care, diagnostic, and laboratory services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Tomas Orozco
Chief Executive Officer
Carlos A. Fernandez-D’Mant
Executive Vice President , Chief Growth Officer
Recent News
2024-04-10
Company data provided by crunchbase