UM/QI Coordinator

About the role

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to easily and equitably accessed healthcare, currently operating in Texas and Arizona. The mission is to ensure underserved communities have access to health and wellness services and receive support to live a healthy life free of worry and full of joy. The UM/QI Coordinator will support daily Utilization Management (UM) and Case Management (CM) operations, including census and admission management, outpatient authorization requests, inpatient notifications, medical record retrieval, discharge and transition-of-care activities, member outreach, and analytical data collection. The role reports to the UM Supervisor and works closely with UM/CM Supervisors, Director, and Chief Medical Officer (CMO) of the Medical Management team to ensure timely processing, accurate documentation, effective communication, and efficient coordination of services. Location: Huntington Beach, CA. Job type: Full-time.

Responsibilities

• Process and coordinate prior authorization, referral, and inpatient notification requests; monitor status, route cases appropriately, follow up on outstanding information, and ensure timely completion.
• Respond to providers, vendors, facilities, and IPAs regarding authorization requests, status inquiries, documentation, and other UM-related needs.
• Request, retrieve, attach, and maintain medical records and supporting documentation for authorization and case management cases.
• Enter and update referral and authorization requests in the appropriate systems.
• Monitor and route phone calls, voicemails, emails, faxes, and mail; assist with provider and facility correspondence as needed.
• Conduct member outreach for case management programs to identify care coordination needs and connect members with appropriate healthcare services, community resources, education, and support.
• Provide administrative and operational support to UM, CM, and QI departments, including maintaining reports, logs, tracking tools, member records, and supporting data collection and analysis.
• Collaborate with internal departments and external providers to resolve authorization, documentation, and care coordination issues.
• Participate in quality and process improvement initiatives and provide general support to the UM department.

Requirements

• Minimum 2 years of experience in managed care with a health plan or IPA.
• Good verbal and written communication skills.
• Working knowledge of Microsoft Word, Excel, and Outlook.
• High school diploma or GED; with one to three months related experience and/or training; or equivalent combination of education and experience.
• Ability to reliably commute to the office location in Huntington Beach, CA, or plan to relocate before starting work.
• Physical demands: regularly sit/walk at a workstation; occasionally lift and/or move up to 25‑50 pounds.

Benefits

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance

Pay

Compensation range: $20‑25 hourly. Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance‑based incentive compensation.

Schedule

Full‑time onsite (100% in‑office). Hours of operation: 9 am – 6 pm, standard business hours Monday to Friday; weekends as needed. Occasional travel may be required for meetings and training sessions.