Coordinator - Utilization Management Outpatient - Notification Call Center - Bilingual (Remote)

Date: Jan 12, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 6290 


Position Summary/Position


Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses.  This position requires that one be organized, ability to multitask with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The Outpatient UM Coordinator will also ensure that provider 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 for monitoring the Right Fax Server.  Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
2. Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
3. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
4. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
5. Communicate with providers in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other UM related correspondence.
6. Assist Management or Utilization Management Nurses as requested.

Experience Qualifications


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

Minimum of three (3) years of experience as a data entry specialist or coordinator.

Preferred Experience


Experience as a data entry specialist or coordinator preferably in an HMO or Managed Care setting.

Education Qualifications


High school diploma or GED required. 

Preferred Education


Associate's degree or Bachelor's degree from an accredited institution preferred.

Professional Certification


Medical Assistant certificate preferred.

Knowledge Requirement


Requires knowledge of ICD-9/10 and CPT codes.  Managed Care or physician office a must.

Skills Requirement


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

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