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This range is provided by OpTech. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $21.00/hr - $28.00/hr
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Senior Professional Recruiter @ OpTech | Follow for insights on job searching, recruiting trends & personal growth OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, pleas e visit our website at www.optechus.com.
Schedule: Monday–Friday, 8:50 AM–5:20 PM EST
FLSA: Non-Exempt
Position Overview
The Utilization Management (UM) Coordinator II supports pre-service, concurrent, and post-service review functions under the guidance of the PSMR Manager. This role coordinates, processes, and tracks incoming and outgoing correspondence, faxes, and authorizations, ensuring timely and accurate handling. The UM Coordinator II serves as a resource to the team, manages complex assignments, provides onboarding and mentorship to new hires, and assists with work distribution and monitoring as needed.
Key Responsibilities
Deliver exceptional telephone customer service to members and providers by addressing benefit questions, resolving inquiries, and ensuring clear understanding of services.
Verify contract and benefit eligibility, insurance coverage, and obtain authorizations when required.
Process prior authorization requests received via phone, fax, or correspondence in accordance with policies and procedures, ensuring accuracy and timeliness.
Forward completed authorization requests to clinicians for medical review.
Enter referrals, document communications, and update departmental systems accurately.
Provide authorizations for inpatient admissions, outpatient certifications, and prior authorization requests.
Maintain proficiency in UM Coordinator activities, stepping in to perform tasks as needed to meet unit goals during staffing or technology challenges.
Act as a liaison between hospitals, physicians, health plans, vendors, patients, and referral sources.
Provide onboarding and preceptorship for new staff, ensuring smooth transitions post-training and reporting performance concerns when appropriate.
Offer guidance and expertise to less experienced UM Coordinators.
Skills & Qualifications
Strong analytical skills with the ability to use sound judgment and resolve problems independently or with minimal guidance.
Effective verbal and written communication skills across all organizational levels.
Excellent organizational and interpersonal skills.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).
Knowledge of medical terminology.
Familiarity with medical management systems, EMRs, and documentation programs.
Typing speed of 50+ WPM with high accuracy.
Preferred
Call center or insurance industry experience.
Knowledge of NCQA Utilization Management guidelines and CMS regulatory requirements.
Basic understanding of LCD/NCD processes and UM functions.
Education & Experience
High school diploma or GED required; Bachelor’s degree preferred.
2+ years of related work experience.
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/
Seniority level Seniority level Associate
Employment type Employment type Contract
Job function Job function Health Care Provider and Other
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at OpTech by 2x
Inferred from the description for this job Medical insurance
Vision insurance
401(k)
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