Utilization Management Coordinator

The Opportunity

• The UM Coordinator will support the Utilization Management function of multiple IPAs in the Inland Valley area to proactively monitor utilization of services for patients. This is an exciting opportunity to be a part of a growing organization, helping to build processes and be part of a team expanding access to exceptional healthcare.

What you'll do

• Manage referral requests received from various systems
• Conduct initial review of authorization requests to verify correct data entry, provider contract status, and completeness
• Process and approve a proportion of authorization requests according to pre-defined criteria, including citing of sources.
• Conduct quality reviews for medical necessity and services provided.
• Review and escalate appropriate referrals to the Medical Director or an RN for review.
• Monitor workflow queues to ensure timely processing of all referrals.
• Keep key templates up to date according to changing health plan requirements.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

Who you are

• Minimum 3 years of experience in a clinical setting, preferably in the Utilization Management
• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Excellent analytical, organizational, and time-management skills.
• Strong communication and collaboration skills across clinical and administrative teams.
• Comfortability with learning new technology.
• Ability to oversee multiple departments simultaneously while ensuring compliance and accuracy.

Benefits

• Medical, Dental and Vision Coverage
• Sick leave hours per year
• Paid holidays per year