Care Coordinator
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Job Description
UM Care Coordinator supporting utilization management authorization and referral workflows. Verifying coverage, coordinating with nurses, and maintaining compliant healthcare records for physician and payer clients.
Responsibilities:
- Support the care management team
- Work directly with Utilization Management Nurses in day-to-day operations
- Assist and monitor the processing of authorization requests
- Document, update, and finalize referrals daily
- Verify providers, member eligibility, benefits coverage, CPT/ICD-10 codes, dates, required fields, and supporting clinical data
- Process referrals within designated timeframes
- Look up information in the DOFR and EOC
- Follow Coordinator guidelines for authorization requests
- Coordinate, identify, and route referrals requiring review to Utilization Management Nurses
- Assist with data entry, updates, and corrections
- Interact with UM nurses and provide timely follow-through
- Take incoming departmental calls
- Call providers, members, and health plans
- Maintain PHI and HIPAA compliance
- Proactively solve problems
- Attend meetings and complete required training
- Perform other duties as needed
Requirements:
- 2 years healthcare administration experience
- 3 years customer service experience
- HMO/Medical Group experience preferred
- Must be able to work 8–5 PM Pacific Standard Time
- Bilingual proficiency preferred
- Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office, Word, Excel, and Adobe
- Strong ability to multitask and work in a fast-paced environment
- Strong problem-solving ability
- Ability to work in an extremely confidential environment
- Strong written and verbal communication skills
- Technology savvy and highly organized
Benefits:
- 100% employer-paid medical coverage
- 100% employer-paid vision coverage
- 100% employer-paid dental coverage
- 100% employer-paid life coverage
- Paid holidays
- Paid sick time
- Paid vacation time
- 401(k) plan
- Additional employee-paid coverage options
- Flexible work environment and schedules
- Work-from-home options
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