UM Coordinator

Utilization Management (UM) Coordinator

The Utilization Management (UM) Coordinator supports the coordination, processing, and administrative functions of the utilization review process. This role ensures timely and appropriate review of healthcare services in accordance with established guidelines and regulatory requirements, working closely with UM nurses, physicians, and other healthcare professionals.

Key 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.

Qualifications :

Skills :

Working Conditions :

The Majority Of Work Responsibilities Are Performed working remotely, Carrying Out Detailed Work Sitting At A Desk / Table And Working On The Computer.

For individuals assigned to a location(s) in California, NeueHealth is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant's education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $19.27-$28.91 Hourly.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.