UM Coordinator

The UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit verification, gathering necessary clinical information from electronic medical record, and timely communication with members, providers and facility staff.

Requirements

• Research and confirm authorization requirements and communicate to member, providers, and facility staff.
• Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation and provider participation status.
• Create cases within documentation system in accordance with departmental workflows, policies, and procedures.
• Maintain accurate documentation within the clinical record according to workflows, policies and procedures.
• Collaborate with the clinical team to address provider or member questions, issues, or concerns.
• Play an active role in continuous improvement activities and quality initiatives to support positive outcomes for members, providers, and clients.
• Maintain professional communication with all internal and external stakeholders.