UM Coordinator

About the Role

The Quality Management (QM) Coordinator supports daily utilization management (UM) and quality management operations by assisting with health plan and regulatory audits, coordinating required reporting, and ensuring compliance with internal policies and external standards. This role provides backup support to the UM team and performs daily audits of referral and authorization data to maintain accuracy and adherence to procedures.

Responsibilities

• Support daily utilization management and quality management operations under the direction of the Delegation Compliance Director.
• Assist with health plan and regulatory audits by preparing documentation, organizing data, and participating in audit activities.
• Coordinate required reporting to health plans and regulatory bodies, ensuring accuracy, completeness, and timeliness.
• Ensure compliance with internal policies and external standards related to utilization management and quality management.
• Provide backup support to the UM team, including handling referrals and authorizations as needed.
• Perform daily audits of referral and authorization data to verify accuracy, identify discrepancies, and ensure adherence to procedures.
• Pull, compile, and format reports using Microsoft Excel and PowerPoint for internal review and external submission.
• Conduct extensive telephonic and text campaign outreach to members to support quality initiatives and care coordination.
• Monitor member responses from outreach campaigns and document outcomes in appropriate systems.
• Assist members with appointment scheduling and follow-up activities to support continuity of care.
• Support the development and tracking of Corrective Action Plans (CAPs) arising from audits or compliance findings.
• Collaborate with utilization management and quality management teams to maintain efficient workflows and meet performance targets.
• Perform detailed, time-sensitive administrative and clerical processes that support UM and QM workflows.
• Interact professionally with diverse clientele, including management and health plan representatives, to address information requests and clarify data.
• Contribute to case management and HEDIS-related activities as needed to support quality reporting and performance improvement.

Requirements

• High school diploma or equivalent education.
• Minimum of 1 year of back-office medical assistant experience OR at least 1 year of experience in utilization management or quality management within a managed care setting (preferred).
• Experience performing detailed, time-sensitive administrative and clerical processes in support of UM or QM workflows.
• Proficiency in Microsoft Office, including Word, Excel, and Outlook.
• Ability to pull, analyze, and present data using Microsoft Excel and prepare presentations using PowerPoint.
• Strong organizational skills with the ability to manage multiple tasks and deadlines in a regulated environment.
• Attention to detail and accuracy when auditing referral and authorization data.
• Effective verbal and written communication skills for telephonic and text outreach to members.
• Ability to work in a managed care setting and understand basic UM and QM concepts.

Qualifications

• Experience as a medical assistant, particularly in a back-office setting.
• Prior experience in utilization management or quality management within a managed care environment.
• Familiarity with utilization management or quality management databases and systems.
• Exposure to health plan audits and regulatory reviews.
• Experience supporting Corrective Action Plans (CAPs) and compliance-related activities.
• Experience in case management or coordination of care activities.
• Understanding of HEDIS measures and quality reporting processes.
• Interest in building skills that can lead to future opportunities in compliance, leadership, or health plan roles.
• Ability to work collaboratively in a small departmental team and contribute to continuous improvement efforts.

Work Environment

This is a fully onsite position in an office-based managed care environment. The role follows a Monday through Friday schedule, typically from 7:30 a.m. to 4:30 p.m., providing a stable daytime work routine. The department consists of approximately nine staff members, offering a close-knit team setting with opportunities for collaboration and skill development. The position is contract-to-hire, allowing for long-term growth potential. Dress code for this role is scrubs, reflecting its connection to clinical operations and patient care support.

This is a Contract position based out of Victorville, CA.

Pay

The pay range for this position is $23.00 - $24.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Benefits

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)