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Job Title: UM CoordinatorJob Description

The Utilization Management (UM) Coordinator is responsible for executing all aspects of the referral process. The UM Coordinator collaborates with clinical team members to evaluate the potential over and under-utilization of specialty services based on clinical protocols. This role involves effective communication and interaction with utilization review nurses and health plans regarding UM and referral authorization issues.

Responsibilities

+ Execute the referral process in collaboration with clinical team members.

+ Evaluate the potential over and under-utilization of specialty services.

+ Communicate effectively with utilization review nurses and health plans on UM and referral authorization issues.

+ Perform data entry in EZ-CAP.

+ Process requests that are approved, denied, or deferred.

+ Maintain and track deferred authorizations and follow up as necessary.

+ Manage the EIOD process including log maintenance and phone calls to members, physicians, and health plans, ensuring follow-up on requests.

+ Maintain compliance with turnaround time standards.

+ Prioritize assigned patient cohorts to ensure specialty referral completion.

+ Ensure stat and expedited referrals are completed based on timeliness standards.

Essential Skills

+ Knowledge of medical terminology.

+ Experience in care management, managed care, and healthcare industry.

+ Proficiency in EZ-CAP and ability to navigate the system.

+ Understanding of health administration and managed care.

+ Case management and healthcare experience.

+ Customer service and data entry skills.

Additional Skills & Qualifications

+ Experience working in a managed care environment.

+ Experience with Independent Physician Associations (IPAs), Managed Care, and Utilization Management.

+ High school diploma or GED required.

+ Preferred background in Managed Care Coordination, Medical Assisting, and/or CNA experience.

Work Environment

This role operates in a remote office environment with a schedule from Monday to Friday, 8am-5pm, including a 1-hour lunch break. Flexibility for early morning shifts may be required, subject to approval by the director, especially when the queue is high.

Pay and Benefits

The pay range for this position is $23.00 - $25.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jul 31, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] (%[email protected]) for other accommodation options.