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.