UM Coordinator

POSITION SUMMARY

Reports to Clinical Operations Manager. The Utilization Management Coordinator is responsible for processing and assisting with 80-100 authorizations per day, reviewing authorizations for accuracy such as completeness which includes correct address, correct provider, all appropriate CPT codes, ICD-10 codes, and correct place of service/facility. Individuals must be able to execute effective communications verbally and in writing. Maintain patient confidentiality and promote departmental and organizational goals. 

RESPONSIBILITIES-DUTIES

• Individuals will be available to assist Licensed Nursing staff with non-clinical tasks associated with the processing of prior authorizations but primarily assist other outpatient UM staff with daily tasks. 
• If a member is not in the system, notifies eligibility by submitting member inquiry.
• Provides benefit and or guideline information to the authorization, Information is uploaded onto the authorization prior to passing to the clinical review UM Nurse, and/or Medical Director. 
• Calls providers to obtain the supporting medical documentation needed for Prior Auth Nurse, and/or Medical Director to review.
• Educates providers as needed with the Authorization/Referral process under the direction on Admin Authorization Supervisor and Outpatient Prior Authorization Coordinator, II & III.
• Maintains confidentiality of all members and medical/clinical information.
• Performs as necessary to any departmental changes, workload and/or emergencies.
• Understands UM Policies/Procedures.
• Ensures the privacy and security of PHI(Protected Health Information)as outlined in AMM policies and procedures relating to HIPPA compliance.
• Performs other duties as directed by Admin Auth Supervisor and/or UM Director.

EDUCATION & EXPERIENCE REQUIREMENTS 

• At least one year of related experience and/or training; or equivalent combination of education and experience preferred. 
• Medical terminology training, medical or other healthcare related experience preferred. May be required to take additional training classes during first six months of employment.
• High school diploma or GED
• Must be able to communicate both orally and in writing.
• Ability to apply common sense, to read and comprehend simple to moderate instructions to carry out basic to detailed written and/or oral instructions.
• Must be able to efficiently prioritize multiple high priority tasks and or follow a set level of tasks assigned.
• Must have the ability to work as a team player, take instructions and follow through with tasks.  Must also be able to follow simple instructions and be organized but requires moderate to minimal supervision. 
• Must maintain strict confidentiality of all patient information and IPA business.

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!