Utilization Management Coordinator

As a Utilization Management Coordinator at Astrana Health, your responsibilities encompass supporting clinical, management, and client activities within the UM Program. You’ll need to process daily UM referrals, ensuring that each request aligns with the health plan standards while maintaining exceptional customer service. Your role includes verifying benefits and eligibility, conducting pre-authorizations, and collaborating closely with healthcare providers to ensure timely and accurate processing of treatments.

To apply for the Utilization Management Coordinator position at Astrana Health, you should have at least a High School diploma and two years of experience in a managed care environment. Familiarity with medical terminology and managed care UM procedures is crucial. Proficiency in Microsoft applications and strong organizational and communication skills will greatly enhance your ability to succeed in this role.

The work environment for the Utilization Management Coordinator at Astrana Health follows a hybrid model, combining office and remote work. This structure promotes a balance between collaborative in-office work at our Monterey Park, CA office and the flexibility of working from home, making it easy for you to be productive while maintaining a healthy work-life balance.

The salary range for the Utilization Management Coordinator role at Astrana Health is between $20 and $24 per hour. This range reflects our national target for this position, demonstrating our commitment to providing competitive compensation for vital roles within our organization.

Astrana Health is dedicated to the professional development of our employees, including Utilization Management Coordinators. We offer ongoing training and educational opportunities to enhance your knowledge of the latest UM procedures and policies, along with support in achieving your career goals through access to our extensive healthcare network.

Successful Utilization Management Coordinators at Astrana Health should possess strong organizational skills and the ability to multitask effectively in a fast-paced environment. Excellent verbal and written communication skills are vital since you'll be interacting with various stakeholders. Additionally, a keen attention to detail and the ability to problem-solve independently will greatly contribute to your success in this role.

At Astrana Health, our company culture is centered around innovation, integrity, teamwork, and a strong focus on our patients. As a Utilization Management Coordinator, you will be welcomed into a collaborative atmosphere where your contributions are valued, and your professional insights are encouraged. We foster an inclusive environment where every team member plays a vital role in improving healthcare delivery and patient outcomes.

When answering this question, share specific examples from your previous roles that demonstrate your familiarity with UM processes such as pre-authorizations and retrospective reviews. Highlight any systems you used and how you ensured compliance with health plan standards, while also emphasizing your commitment to quality patient care.

To effectively answer this question, discuss your organizational strategies such as using priority matrices or software tools to manage tasks. Explain how you assess urgency and importance when handling 150-250 referrals daily, ensuring that you meet turnaround time guidelines while maintaining accuracy.

Detail your approach for verifying provider status, including the key factors you consider such as contracting, eligibility, and membership verification. Emphasize your methodical nature and the importance of ensuring that the facilities are approved by CMS when required.

Discuss your knowledge of specific UM policies and procedures and how you ensure compliance in your daily operations. This could include regular reviews of policies, ongoing training, and communication with team members to foster a compliant work environment.

Prepare a scenario demonstrating your problem-solving skills and adaptability. Describe a challenge you encountered, such as processing delays or discrepancies in referrals, and outline the steps you took to resolve the issue while ensuring minimal impact on patient care.

Reflect on your customer service philosophy and share actionable strategies, such as clear communication, empathy, and timely follow-ups. Provide an example where your approach garnered positive feedback from providers or clients to show the importance of patient-centric service.

Highlight your commitment to ongoing education and professional development. Mention specific resources, such as industry publications, webinars, or professional organizations, that you engage with to stay informed about changes in Utilization Management and healthcare regulations.

Be specific about the software tools you are familiar with, mentioning any EMR systems, databases, or reporting tools. Talk about how you leveraged these tools to streamline processes and improve the efficiency of handling UM referrals.

Talk about your conflict resolution skills and how you tailor your communication style to the individual’s needs. Provide an example of how you’ve successfully navigated a difficult interaction by being patient, understanding their concerns, and finding a mutually agreeable solution.

This is an opportunity to reflect on your personal values. Discuss qualities such as attention to detail, empathy for patients, or strong analytical skills. Explain why you believe this quality is crucial for the role and how it aligns with Astrana Health's mission of improving patient outcomes.