UM Coordinator I (Sunday-Thursday)

$35.54k - $56.87k

Full-time

PacificSource

Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
The Utilization Management (UM) Coordinator I is fundamental to the utilization management team and receives, researches, and coordinates initial and follow-up action related to clinical documentation and requests from a variety of sources. Adheres to rigorous regulatory requirements, builds team collaboration, contributes to team improvements, and creates enhanced member and provider partner relationships.
Essential Responsibilities:
High level - Adhere to dependability, member and provider focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all functions.
Follow stringent guidelines to ensure all work meets PacificSource corporate standards for accuracy and compliance with federal, state, and national accreditation regulations.
UM Process - Coordinate, create, and document UM cases in the electronic record by validating preauthorization requirements, utilizing a basic understanding of ICD, CPT and HCPCS codes, and including plan types, member benefits, eligibility, limitations, exclusions, and claims history.
Assess accuracy of daily inpatient information from external systems and inpatient facilities, compile inpatient data, create inpatient events including diagnosis codes, and triage for review by UM and CM clinical staff.
Collaborate with clinical staff by synchronizing information for utilization management, care management, prior authorization, inpatient stay, and retroactive claim reviews. Integrate medical records as required and document status of internal or external reviews in the medical record. Identify and promptly initiate corrective steps to resolve workflow issues.
Administratively authorize services as directed by UM Leadership.
Effectively manage an active telephonic queue by delivering excellent customer service to incoming caller and documenting HIPAA compliance. Provide information on prior authorization, referrals, inpatient admissions and stays, health-related information, determinations, claims review, and possess an understanding of when to forward members and providers to Appeals and Grievances. Manage difficult calls and escalate or triage calls to more experienced staff as necessary.
Work between multiple systems, utilizing critical thinking and problem-solving skills while successfully keeping the member at the center.
Identify and keep readily accessible all up-to-date reference documents, policies and procedures needed to be successful.
People - Attend and contribute to cross-functional member-focused meetings, educate team members on UM functions, and assist members in getting the right care at the right time.
Utilize knowledge, understanding and critical thinking to research difficult cases related to UM processes and requirements from members, providers, employer groups, agents, member representatives and internal customers.
Serve as a liaison between members and providers regarding benefit utilization and requirements. Provide education and facilitate the member and provider understanding and experience of utilization processes, including benefit structure, contract parameters, and of the information necessary to effectively complete a prior authorization or inpatient stay.
Supporting Responsibilities:
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of two years of experience in health insurance industry or medical setting required. One year experience working with CPT/HCPCS/ICD coding preferred. Other equivalent professional related experience may be considered.
Education, Certificates, Licenses: High school diploma or equivalent required, associate degree, medical assistant certification, licensed professional nurse or certified professional coding certification preferred.
Knowledge: Demonstrated basic knowledge and understanding of medical terminology, procedures, anatomy, diagnoses, care modalities, treatment plans, and medical coding. Basic understanding of insurance, and standard medical billing practices preferred. Proficient computer, and strong written and verbal communication skills. Strong organizational skills and experience with Microsoft Office programs, medical, and claims management software. The ability to work independently at times with minimal supervision.
Competencies
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
Continuous Improvement
Adaptability
Building Trust
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Compensation Disclaimer
The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.
Base Range:
$35,542.81 - $56,868.50
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Apply

Vacancy posted 16 hours ago

Similar jobs that could be interesting for youBased on the UM Coordinator I (Sunday-Thursday) in Portland, OR vacancy

Life Enrichment Coordinator
$23 - $25 per hour
The Life Enrichment Coordinator is responsible for the creation and implementation of the recreation program designed to enrich... ...throughout the Residence. This is a Full-time, non-exempt, Sunday through Thursday 10:ooam - 6:30pm position. Duties and Responsibilities: Collaborate...
Sunday
Full time
Interim role
Work at office
Flexible hours
Shift work
Maybelle Center
Portland, OR
4 days ago
Party Coordinator
$20 per hour
Join to apply for the Party Coordinator role at Urban Air Adventure Parks 6 months ago Be among the first 25 applicants Join to apply for... ...strive for 100% "Guest Satisfaction"! Friday, Saturday, and Sunday full availability is a must! You must be able to represent! We...
Sunday
Full time
Part time
Casual work
Weekend work
Afternoon shift
Urban Air Adventure Parks
Vancouver, WA
1 day ago
Assistant Coordinator
...development Portland Lil’ Kickers is looking for high-energy Assistant Coordinators / Lead Coaches who can both coach and help run the daily... ...Southeast Portland and Beaverton locations, we are hiring a: Sunday-Wednesday Lead Wednesday-Saturday Lead Weekday shifts: 8:30...
Sunday
Summer work
Seasonal work
Local area
Flexible hours
Shift work
Weekend work
Day shift
Weekday work
Lil' Kickers of Portland
Portland, OR
1 day ago
Occupational Therapy Assistant
...Rehabilitation Center located in Portland, OR. Position Highlights: Work-life balance: Flexible schedule Tuesday - Saturday or Sunday - Thursday Technology: Utilization of NetHealth for point of service documentation with laptop or iPad Clinical Expertise: We are...
Sunday
Flexible hours
Weekend work
Infinity Rehab
Portland, OR
1 day ago
Locum Nurse Practitioner (NP) - Family Practice in Portland, OR
...Schedule Monday: Not Specified, Tuesday: Not Specified, Wednesday: Not Specified, Thursday: Not Specified, Friday: Not Specified, Saturday: Not Specified, Sunday: Not Specified Dates Needed - Alumni Healthcare Staffing offers:...
Sunday
Weekly pay
Full time
Contract work
Locum
Work at office
Immediate start
Flexible hours
Shift work
Weekend work
2 days per week
3 days per week
1 day per week
Alumni Healthcare Staffing
Portland, OR
1 day ago
CT Technologist
...and Schedules Available:Full-Time/Day – Saturday from 7a-7:30p & Sunday-Monday from 9a-9:30pFull-Time/Day – Friday from 7a-7:30p &... ...-Wednesday from 8a-6:30pFull-Time/Day – Monday from 7a-7:30p & Thursday-Friday from 7a-7:30pFull-Time/Night – Thursday-Saturday from 7p...
Sunday
Full time
Shift work
Night shift
Weekend work
MedTeam Staffing
Portland, OR
2 days ago
Locum Physician Assistant (PA) - Cardiology - General/Other in Portland, OR
...Schedule Monday: Not Specified, Tuesday: Not Specified, Wednesday: Not Specified, Thursday: Not Specified, Friday: Not Specified, Saturday: Not Specified, Sunday: Not Specified Dates Needed - Alumni Healthcare Staffing offers:...
Sunday
Weekly pay
Full time
Contract work
Locum
Immediate start
Flexible hours
Shift work
Night shift
1 day per week
Alumni Healthcare Staffing
Portland, OR
1 day ago
CNA
$22.5 - $28.8 per hour
...Overview CNA Pay: $22.50 - $28.80 / hour DOE Schedules Available: Full Time Eve 3pm-11pm: Tuesday, Thursday, Friday, Saturday, Sunday Full Time Day 7am-3pm: Tue, Wed, Thur & Saturday OR Sunday Mirabella Portland, a part of Pacific Retirement...
Sunday
Full time
Weekend work
PRS Management, Inc.
Portland, OR
1 day ago
Prior Authorization Coordinator I
$21.3 - $23.96 per hour
...information to process prior authorizations and referrals and coordinates with providers to ensure consideration is given to unique treatment... ...for services. Enter data into appropriate system Facets UM or CT Dynamo must be able to accurately determine member eligibility...
Hourly pay
Contract work
Work at office
Remote work
Work from home
Shift work
Afternoon shift
Moda Health
Portland, OR
4 days ago
CT Technologist
$6,000 per month
...Schedules Available: Full-Time/Day - Saturday from 7a-7:30p & Sunday-Monday from 9a-9:30p Full-Time/Day - Friday from 7a-7:30p &... ...from 8a-6:30p Full-Time/Day - Monday from 7a-7:30p & Thursday-Friday from 7a-7:30p Full-Time/Night - Thursday-Saturday from...
Sunday
Full time
Part time
Relocation package
Shift work
Night shift
Weekend work
MedTeam Staffing
Portland, OR
4 days ago
Costco Roadshow - Sales Rep
...variety instead of a nine-to-five. What a roadshow looks like: Thursday — setup. Product arrives on pallets. You build the display,... ...the finished setup. This day is physical. Friday through Sunday — the heavy days. Warehouse traffic peaks and the show's number...
Sunday
Shift work
Weekend work
Day shift
Afternoon shift
Weekday work
Acosta
Portland, OR
2 days ago
In Home Caregiver
...and Wednesday 11a-6pm. Monday and Wednesday 3p-6:30p and Tuesday/Thursday 1p-4:30pm. Saturday 12 hr shift from 10:30a-10:30pm. Tuesday/... .../Friday 11:30a-4:30p. Monday-Friday 8:30a-12:30p. Saturday and Sunday 12p-4pm. Wednesday/Saturday 3p-5p. Wednesday 3p-8pWest Linn, Wilsonville...
Sunday
Weekly pay
Monday to Friday
Flexible hours
Shift work
Weekend work
Family Resource Home Care
Portland, OR
5 days ago
Dining Room Server ~ FT/PT ~ Senior Living Community ~ Portland
$20 per hour
...Dining Room Server Full-time/Part-time Pay Rate: $20.00 Non-exempt Schedule: FT - Sunday - Thursday ~ Shift to be discussed at time of interview at the community. PT - Saturday & Sunday ~ Shift to be discussed at time of interview at the community...
Sunday
Full time
Part time
Shift work
Weekend work
MorningStar Senior Living
Portland, OR
2 days ago
Pharmacist - Long Term Care - Full Time
$55.53 - $93.08 per hour
...This is a full-time overnight position with a 7 on/7 off schedule. Schedule is 7 days on/7 days off. Monday-Thursday 8pm-6:30am Friday and Saturday 8pm-8am Sunday 8pm-6:30am.Omnicare, Inc. is a wholly owned subsidiary of CVS Health Corporation. Following the sale of...
Sunday
Hourly pay
Full time
Night shift
Weekend work
Afternoon shift
CVS Corporation
Portland, OR
2 days ago
Treatment Coordinator
$600 - $2,500 per month
...our patients and communities. At Gentle Dental, our Treatment Coordinators manage patients full cycle from clinical diagnosis to treatment... ...99 Vancouver, WA 98665, USA Schedule Full-time, Monday-Thursday Gentle Dental has the resources you need to achieve true personal...
Hourly pay
Full time
Part time
Immediate start
InterDent Service Corporation
Vancouver, WA
4 days ago
Crisis Response Dispatch Coordinator
Cascadia Health is seeking a Dispatch Coordinator for the Project Respond program at the Kerns Building in NE Portland. This 90-day assignment runs Monday through Thursday, 10:00 a.m. to 8:30 p.m., coordinating mobile crisis teams and gathering critical information from...
Monday to Thursday
Cascadia Health
Portland, OR
4 days ago
Scheduling Coordinator
$25 - $30 per hour
Overview City Dental is seeking an experienced Scheduling Coordinator to join our team! The ideal candidate will have experience in a dental... ...we encourage you to apply today! Schedule Full-time Monday - Thursday, 7:30 AM - 5:00 PM Fridays, 7:30 AM - 2:00 PM Compensation and...
Hourly pay
Full time
City Dental
Portland, OR
4 days ago
Life Enrichment Associate (Activities Assistant)
$17 - $19 per hour
...Memory Care Full Time Day Shift Potential for some varrying hours depending on department needs Tuesday-Saturday or Sunday-Thursday Weekend Availability Required Cascade Living Group Benefit Offerings: ~ Competitive wages ~ Career Pathways ~...
Sunday
Full time
Flexible hours
Weekend work
Day shift
Regency Park
Portland, OR
a month ago
Sales Assoc
...customer follow-up skills· Ability to complete and coordinate complex large orders within a variety of sales channels... ...shifts on the weekend** (Friday, Saturday and/or Sunday) and two during the week (Monday to Thursday). For an associate to be scheduled 20 hours or more...
Sunday
Full time
Part time
H1b
Local area
Home office
Relocation package
Flexible hours
Shift work
Weekend work
Williams-Sonoma
Portland, OR
3 days ago
Dental Hygienist
$60 per hour
...experience Office Hours Monday: 7:00 AM - 4:00 PM Tuesday: 7:00 AM - 5:00 PM Wednesday: 7:00 AM - 4:00 PM Thursday: 6:00 AM - 3:00 PM Friday: Off Saturday: Off Sunday: Off What You'll Love About This Opportunity Supportive and collaborative team environment 1 hour+...
Sunday
Full time
Part time
Work at office
Local area
Imagen Dental Partners
Gresham, OR
1 day ago
Final Assembly Lead
...a working lead position responsible for coordinating daily activities, providing technical guidance... ...Day Shift (4 x 10s): Monday through Thursday, 5:00 AM to 3:30 PM Swing Shift (4 x 10... ...Weekend Shift (3 x 12s): Friday through Sunday, 5:00 AM to 5:30 PM What You'll Do...
Sunday
Hourly pay
Temporary work
Monday to Thursday
Shift work
Weekend work
Day shift
Afternoon shift
3 days per week
Fulcrum Technologies Inc.
Tualatin, OR
2 days ago
Hospital Phlebotomist
...advance care. Join us in our mission to improve health and improve lives.Work Schedule: Rotating Schedule 10:00PM - 7:30AM, Thursday-Saturday and Sunday-Wednesday followed by a week off.Job Responsibilities:Perform blood collections by venipuncture and capillary techniques...
Sunday
Temporary work
Work experience placement
Casual work
Internship
Flexible hours
Weekend work
LabCorp
Portland, OR
2 days ago
Client Services Representative
$17 - $19.5 per hour
...19.50 per hour, depending on experience. Schedule We are especially looking for availability on Mondays, Tuesdays, Thursdays, Saturdays, and/or Sundays. You do not need to be available for every shift to apply. DolFUN Dynamics is an Equal Opportunity Employer and welcomes...
Sunday
Hourly pay
Flexible hours
Shift work
Weekend work
Afternoon shift
DolFUN SWIM Academy
Portland, OR
1 day ago
Patient Care Technician - Patient Care Technician
...Location: Portland, OR Start Date: ASAP Shift: 5 x 8hr; Sunday - Thursday NOCs Ratios: 1:15-25 Years of Experience Required: 1... ...grooming with minimal support and supervision. Schedules and coordinates tasks to be performed by other PCTs, in cooperation with...
Sunday
Local area
Immediate start
Shift work
Weekend work
Bestica Healthcare
Portland, OR
1 day ago
Driver (Non CDL)
...0 AM-2:00 PM2 Open - Weekday Shift: Monday-Thursday, 2:45 PM-12:45 AM (4 x 10-hour shifts)1 Open - Weekend Shift: Friday-Sunday, 6:00 AM-6:30 PM (3 x 12-hour shifts)Nice to... ...experienceJob Description:Overview: To coordinate, track, and document the movement of parts...
Sunday
Monday to Friday
Shift work
Weekend work
Weekday work
Insight Global
Portland, OR
5 days ago
Visual Merch - Store
...must be available to work a minimum of two regularly scheduled shifts on the weekend (Friday, Saturday and/or Sunday) and two during the week (Monday to Thursday). For an associate to be scheduled 20 hours or more weekly, greater availability (beyond the minimum required...
Sunday
Full time
Part time
Home office
Flexible hours
Shift work
Weekend work
Rejuvenation
Portland, OR
5 days ago
Assembler - Manufacturing
...Tualatin, OR Work area: Production Pay: 18.00 Shift Schedules Day shift: Monday–Thursday, 6:00 a.m.–4:30 p.m. Swing shift: Monday–Thursday, 5:00 p.m.–3:30 a.m. Weekend shift: Friday–Sunday; hours to be confirmed. What You’ll Do Perform repetitive workstation or production...
Sunday
Shift work
Weekend work
Day shift
Afternoon shift
Employers Overload
Tualatin, OR
3 days ago
Caregiver
$19 - $21 per hour
...Full Time Day Shift (6a-2p) Tuesday - Saturday Swing Shift (2p-10p) Thursday- Monday Weekend and Holiday Availability Required Assisted Living Openings: Full Time Day Shift (6a-2p) Wednesday-Sunday In addition to a wide variety of career opportunities, we offer a...
Sunday
Full time
Flexible hours
Weekend work
Day shift
Afternoon shift
Royalton Place
Milwaukie, OR
5 days ago
Packaging Operator
....Alternative Work Schedule: 12-hour shifts, 3 or 4 days per week Front Half Days: Sunday, Monday, Tuesday, every other Wednesday 6am-6:30pmBack Half Days: Every other Wednesday, Thursday, Friday, Saturday 6am-6:30pmFront Half Nights: Every other Saturday, Sunday, Monday...
Sunday
Shift work
Night shift
Weekend work
3 days per week
Campbell Soup Company
Tualatin, OR
1 day ago
Local Dedicated Intermodal- Home Daily
$44 per hour
...Troutdale Terminal Portland Dropyard Home Daily, Slip seat, Day cab Morning or Evening Starts 10-12 hour shifts Sundays - Thursdays or Tuesdays - Saturdays Picking up and dropping off containers along the railways Walmart Freight to Hermiston, OR...
Sunday
Daily paid
Local area
Shift work
Day shift
Afternoon shift
1 day per week
A man with a Plan Services LLC
Portland, OR
9 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to UM Coordinator I (Sunday-Thursday). Be the first to apply!