Insight Global is looking for a UM Coordinator for one of their largest healthcare clients located in Irvine.

* Applies knowledge/skills to activities that can vary from day to day.

* Demonstrates a moderate level of knowledge and skill in own function.

* Requires minimal assistance with referral requests.

* Solves routine problems independently.

* Works with supervisor and senior coordinators to solve more complex problems.

* Prioritizes and organizes own work to meet turnaround time and deadlines.

* Works with others and communicates with team to meet overall goals of work completion within set timeframes.

* Processes work as assigned within established timeframes and productivity and quality goals using department resources and procedures with minimal oversight:

At minimum, meet the UM Coordinator daily productivity performance

threshold of 65 authorizations/day and quality assurance score of 95%

or greater on weekly chart audits.

* Enters referral requests into on-line system and approve requests per guidelines for pass-through services, under the supervision of the team Nurses and leads.

* Verifies eligibility and benefits.

* Researches all administrative issues before directing to the team Nurses.

* Manages calls for the team utilizing standard protocols.

* Utilizes online systems to access required information for the team.

* Acts as initial contact and resource related to outreach, screening and education of providers for authorization processing.

* Communicates with members, family or caregiver when appropriate, as directed.

* Actively works to improve departmental communication and processes.

* Acts as resource for Clinical Services Department staff, inter-departmental staff, and Health Plans and provider offices.

* Follows record management and documentation protocols.

* Maintains confidentiality of all member information and Optum Care Network- Monarch business.

* Assists with retro review claims process as needed.

* Supports peers on team with other duties to help maintain turnaround times.

* Performs other duties as assigned.

* Maintains a professional demeanor at all times modeling company core values of integrity, compassion, relationships, innovation and performance

* Maintains regular and consistent attendance.

Duties include but are not limited to:

* Sorts, filters and extracts data from reports and systems to create health plan required reports.

* Assist with projects geared to improve efficiency and cost savings

* Document preparation for health plan audits.

* Interaction with various health care facilities or providers for medical record request and retrievals.

* Ability to facilitate meetings with health care facilities

* Maintain data logs

* Uses, protects, and discloses our company's patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

* Perform additional duties as assigned



We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.

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