Bilingual Compliance UM Coordinator 3

Location: Remote Nationwide

Become a part of our caring community

Become a part of our caring community

The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Bilingual in English and Spanish with full professional proficiency; able to successfully pass required examinations.

The Compliance (UM) Coordinator 3 collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related workstreams. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of action. Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

Required Qualifications

• 1 - 3 years of technical experience
• Proficient in Microsoft Word & Excel
• Strong attention to detail and accuracy
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Excellent verbal and written communication skills
• Clerical support background in a healthcare environment
• Ability to work independently in an agile environment under general instructions and within a team.
• Bilingual in English and Spanish with full professional proficiency; able to successfully pass required examinations.

Preferred Qualifications

• UM experience with auditing or compliance
• UM experience with processing expedited requests or QIO appeals
• The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months
• Associates' or Bachelor's degree in Healthcare, Business. Finance, or related field
• Familiarity with medical terminology and/or ICD-10 codes
• This position is within a department that operates in EST.
• This position offers a flexible schedule of Monday to Sunday, between 8 am and 8 pm EST with occasional overtime.
• This position follows a 4-day workweek consisting of ten-hour shifts, available schedules include:

Monday-Thursday

Tuesday-Friday

Wednesday- Saturday*

Thursday- Sunday*