UM Coordinator - Hybrid

Job Description

Job Description

Description

The Utilization Management (UM) Coordinator is responsible for accurate data entry and timely processing of authorization requests for inpatient and outpatient services, including out-of-network specialist referrals. The role supports the coordination and distribution of medical records, providing essential administrative and clerical assistance to the department. The UM Coordinator ensures that authorizations are processed in a timely manner and in compliance with health plan and regulatory standards, while maintaining excellent customer service and organizational efficiency. The position also requires on-site presence at the Johnston office at least two days per week.

What You'll Do

• Perform accurate and timely data entry of authorization requests for inpatient and outpatient services, ensuring insurance information is correct and updated in IDX and Essette.
• Reconcile referrals daily between fax, phone, and system records to prevent missed cases. Obtain and distribute medical records to UM Nurses.
• Provide PCP notifications of patient admits and discharges.
• Handle stat calls and maintain coverage of UM department phone lines during business hours (8 : 00 AM–4 : 30 PM), ensuring provider and member access.
• Adhere to coverage queue standards, meeting the required 24-hour turnaround time per policy.
• Respond promptly to inquiries and document all interactions in IDX / Essette.
• Notify members and providers of outcomes the same day for all stat requests.
• Assist UM Nurses with the creation and mailing of denial letters, ensuring accuracy in grammar and formatting.
• Maintain fax pods, queues, and filing systems. Scan and distribute documents in a timely manner.
• Process mail (standard, overnight, courier) as needed to meet timeliness standards.
• Conduct outreach to requesting physician offices for additional clinical information to support requests.
• Demonstrate sound judgment, maintain confidentiality, and comply with policies and HIPAA regulations.
• Provide backup support for Case Management Coordinators.
• Complete ad hoc projects and other duties as assigned.
• Consistently deliver excellent customer service and contribute to a clean, organized, and efficient department.
• Other duties as assigned.

Qualifications

Environmental Job Requirements and Working Conditions

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information :

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.