Utilization Management Coordinator

The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. 

• →Monitor incoming faxes
• →Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
• →Verify eligibility and claim history in proprietary claims platform
• →Verify all necessary documentation has been submitted with authorization requests
• →Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
• →Generate correspondence and assist with faxing/mailing member and provider notifications
• →Complete verbal notifications
• →Document as required in authorization platform
• →Initiate appeal cases and forward to UM Nurses for completion
• →Meet internal and regulator deadlines for UM cases
• →Complete tasks assigned by UM Nurses and document as required
• →Complete inquiries received from call center and other internal & external sources
• →Other duties as assigned by UM Director
• →Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
• →Team oriented and self-motivated with a positive attitude

• Verbal notifications
• How to work in authorization systems Essette and Salesforce
• Incoming/outgoing faxing process
• Understanding the expectations and functions of the UM team
• Time Management

• Expand knowledge of ICD-10 and HCPC codes
• Maintaining expected timelines

• 1 year as a UM Coordinator in a managed care payer environment preferred
• Knowledge of ICD-10, HCPCS codes and medical terminology required
• Ability to prioritize multiple tasks using time management and organizational skills
• Strong computer skills with proficiency in Word, Outlook and other software applications
• Ability to collect data, establish facts and draw valid conclusions
• Effective written and oral communication skills
• Experience with DMEPOS desired
• Medicare/Medicaid experience a plus

We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.

Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.

With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.

Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.