Coordinator - UM Member Call Center Bilingual English/Spanish (Remote)

Date: Jan 12, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 6497 


Position Summary/Position


Under the general direction of the UM Manager of Operations and Supervisor, the Member UM Call Center Coordinator, is a high paced position that requires timely answering of telephone calls from Members, asking to complete, create, redirect and/or service authorization requests.  This position requires that one be organized, ability to multitask, set priorities and manage time effectively. a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The UM Coordinator will also ensure that Member calls are responded to in an accurate and timely manner while always maintaining highest level of customer service.


This is a Bilingual (English/Spanish) position. The team member in this role must take a language proficiency assessment.

Major Functions (Duties and Responsibilities)


1. Responsible to manage large amounts of inbound Member calls in a timely manner.
2. Develop a sustainable working relation with Members and Providers by offering excellent customer support, ensuring that their needs are met, and going the extra mile by engaging to problem solve and find solutions. 
3. Responsible to provide service to Members by approving, redirecting, modifying, correcting, and/or creating Member’s authorizations by accurately entering information as requested by Provider and creating new authorization that will allow Providers to render services.  
4. Responsible for utilizing job aids, guides, and tools to ensure that the Provider’s request can be completed within the rules and/or restrictions in our guidelines.
5. Identify Member’s needs, clarify information, research every issue and provide solutions and/or alternatives.
6. Document and keep records of your process and all conversations in MedHOK in a comprehensible way.
7. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level and to collaborate with other Team Members to ensure that the entire team is also successful at meeting those standards.
8. Responsible for meeting the QA standards for phone calls and to collaborate with other Team Members to ensure that the entire team is also successful at meeting those standards.
9. Responsible for representing the Inland Empire Health Plan in a professional, courteous and friendly manner while answering the calls for the Utilization Management Department.
10. Assist UM Management or Utilization Management Nurses as requested.

Experience Qualifications


Bilingual (English/Spanish) - written and verbal skills required.


Minimum of one year of experience as a Call Center Representative.

Preferred Experience


Experience as a Caller Center Representative preferably in an HMO or Managed Care Setting. Managed Care or physician office experience preferred.

Education Qualifications


High School Diploma or GED required.

Preferred Education


Associate Degree from an accredited institution preferred.

Professional Certification


Medical Assistant certificate preferred. 

Knowledge Requirement


Knowledge of ICD-9/10 and CPT code preferred.

Skills Requirement

Knowledge of computer applications, including word processing, database and spreadsheets. Good customer service skills a must.

Commitment to Team Culture


The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions


While performing the duties of this job, team member is occasionally required to stand; walk; sit; use hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and use taste or smell. The team member must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.


Starting Salary: $38,563.20  - $45,302.40  

Pay rate will commensurate with experience


Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles