UM Coordinator

🔥 23 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $19 - $28 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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NeueHealth

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

NeueHealth is a healthcare company focused on providing accessible, affordable, and high-quality care to all health consumers. Formerly known as Bright Health, it operates through two primary segments: NeueCare, which delivers comprehensive healthcare services via owned and affiliated clinics, and NeueSolutions, which supports independent providers in performance-based care arrangements. With a strong emphasis on understanding patient needs, NeueHealth aims to align the interests of health consumers, providers, and payors to enhance healthcare experiences and outcomes.

📋 Description

• 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.

🎯 Requirements

• High School Diploma or equivalent required; Associate’s degree or healthcare certification preferred. • 2+ years of experience in health plan environment; experience in utilization management or case management support strongly preferred. • Capacity To Interpret Health Plan Benefit Decisions. • Bilingual Preferred (English/ Spanish) • Certification As A Medical Assistant Preferred.

🏖️ Benefits

• Health benefits • Life and disability benefits • 401(k) savings plan with match • Paid Time Off • Paid holidays