Utilization Management (UM) & Claims Coordinator

📋 Description

• Manage referral requests from multiple systems for Inland Valley UM.
• Review authorization requests for data accuracy and contract status.
• Process and approve authorizations per predefined criteria.
• Perform quality reviews for medical necessity and services.
• Review and escalate referrals to Medical Director or RN.
• Provide ongoing staff training on documentation and medical necessity.

🎯 Requirements

• Minimum 3 years of experience in a clinical setting, UM preferred.
• Preferred advanced degree in Social Work, Behavioral/Mental Health, Nursing, or related field.
• Excellent analytical, organizational, and time-management skills.
• Comfortable learning new technology.
• Ability to oversee multiple departments while ensuring compliance.
• Must have high school diploma or equivalent.

🎁 Benefits

• Medical, Dental and Vision Coverage.
• Life Insurance and Short-Term Disability.
• 401(k) Savings Plan.
• 401(k) Company Match.
• Paid time off (PTO) hours per year.
• Paid holidays per year.