California Utilization Management Coordinator

Job Summary

Supporting clinical and management activities, the full-time California Utilization Management Coordinator will process treatment authorization requests, ensure compliance with UM policies, and maintain relationships with health plans while working remotely from California.

Key responsibilities

• Process routine and urgent treatment authorization requests according to established policies
• Accurately review and manage daily assigned UM referrals in line with health plan guidelines
• Maintain confidentiality and foster positive relationships with health plans and medical directors

Required qualifications

• High School Graduate; Bachelor's in Healthcare Administration is a plus
• Minimum of two years' experience in a managed care environment, preferably with authorizations or referrals
• Knowledge of medical terminology, including RVS, CPT, HPCS, and ICD-9 codes
• Proficiency in Microsoft applications
• Strong organizational skills and ability to work independently while following departmental standards