UM Clinical Services Coordinator – Managed Care

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  • 20-00139
  • Full Time/Contract
  • Recruiting
  • Pasadena, CA
Job Description
UM Clinical Services Coordinator

The UM Clinical Services Coordinator process authorizations and ensure that all information is correct before submitting for approval. All authorizations should be entered within a timely manner with complete data as well as the all the documents that will support medical necessity. The UM Coordinator will need to provide strong written/communication skills with Medical Director, Providers, and members to ensure the delivery of high-quality effective healthcare.

  • Open and process UM incoming faxes periodically throughout the business day
  • Answer phones: Providing customer service to calls from providers and /or members
  • Print approvals and modification letters from the database on a daily basis
  • Scan any faxes to existing authorizations in the system
  • Route medical reviewer's cases to appropriate personnel in timely manner on a daily basis
  • Verify duplicate requests and call/notify doctor's office of referral request cancellations
  • Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours)
  • Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval
  • Must have experience in making outgoing phone calls as well as taking incoming phone inquiries **Perform additional UM functions as required by the department


  • High School Diploma or equivalent required
  • Minimum 1-year authorizations/referral processing experience in a utilization management setting highly desired
  • High volume (in/outbound) call experience required
  • Considerable knowledge of Medi-Cal/Medicare Managed Care
  • Proficiency in 10-key and MS Office applications
  • Ability to work effectively and accurately in a fast-paced environment  
  • Strong work ethic, detail oriented and self-motivated


  • Full-Time/Contract/Non-Exempt
  • $15.00/hr – $18.00/hr  


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