Outpatient UM Coordinator

Benefits:

• 401(k)
• 401(k) matching
• Bonus based on performance
• Company parties
• Dental insurance
• Employee discounts
• Free food & snacks
• Health insurance
• Opportunity for advancement
• Paid time off
• Parental leave
• Savings bank
• Training & development
• Vision insurance
• Wellness resources

About the Role:
MedPOINT Management is looking for a dedicated Outpatient Utilization Management Coordinator to join our team in Sherman Oaks, CA. In this role, you'll play a critical part in ensuring members receive timely, appropriate care by supporting the prior authorization and utilization review process. If you're passionate about healthcare coordination and making a real difference in patient outcomes, we want to hear from you!

Responsibilities:

• Process and review outpatient prior authorization requests in accordance with clinical guidelines and plan criteria
• Coordinate with physicians, specialists, and healthcare providers to facilitate timely utilization management decisions
• Maintain accurate and up-to-date documentation of authorization requests, approvals, and denials in the UM system
• Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support medical necessity determinations
• Communicate authorization decisions and status updates to members, providers, and internal teams
• Ensure compliance with state, federal, and health plan regulatory requirements for utilization management
• Collaborate with the clinical team to identify and escalate cases requiring physician review

Requirements:

• Active LVN, RN, or equivalent clinical license preferred; medical background required
• 1-3 years of experience in utilization management, prior authorization, or managed care
• Familiarity with IPA, HMO, or managed care plan operations strongly preferred
• Knowledge of InterQual or Milliman clinical criteria guidelines is a plus
• Strong understanding of outpatient medical terminology, CPT, and ICD-10 coding
• Excellent organizational skills with the ability to manage high-volume authorization queues
• Proficient in UM software systems and Microsoft Office Suite
• Detail-oriented, collaborative, and committed to regulatory compliance and quality care

About Us:
MedPOINT Management is a leading Independent Practice Association (IPA) management company based in Sherman Oaks, CA, providing comprehensive administrative and managed care services to physician networks across Southern California. Our providers trust us to deliver efficient, patient-centered solutions that streamline operations and improve care quality. Our team members thrive in a supportive, mission-driven environment where their work directly impacts the health and well-being of the communities we serve.

Flexible work from home options available.