Authorization Referral Coordinator

Trinity Health

79d • $17 - $26

About The Position

Join our dynamic team. The Loyola Physicians Partners, part of the Loyola Health System has an exciting opportunity at our Westchester location. We are currently looking for an experienced Authorization Referral Coordinator. Reporting to the Manager of Utilization Management and working under general supervision, manages Utilization resources and quality of healthcare services through performing initial intake, support and processing of pre-certification requests for eligible members received via portal, EHR, or telephonic, for outpatient and inpatient elective services specified on the preauthorization required list. Utilizes health plan scope of benefits, medical policies, organizational approved medical necessity criteria and home network capabilities to determine if a request meets the guidelines for approval. Approves services under the supervision of the clinical team per protocol. Refers requests to the nurse reviewer or medical director if criteria or guidelines not met.

Requirements

• Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) or Licensed Practice Nurse (LPN) preferred.

Responsibilities

• Review, process, and approve pre-certification requests under clinical supervision.
• Verify documentation, eligibility, and provider/network status.
• Communicate with providers for additional information and assist with in-network referrals.
• Escalate requests to nurse reviewers or medical directors when guidelines are not met.
• Respond to inquiries from providers and members with professionalism and accuracy.
• Support care coordination, continuous process improvement, and departmental policy development.

Benefits

• Benefits from Day One (Medical and Dental)
• Daily Pay 'NEW'
• Competitive Shift Differentials
• Career Development
• Tuition Reimbursement
• Participation in the Public Service Loan Forgiveness Program
• 403(b) with Employer Match
• On Site Fitness Center (Gottlieb Memorial Hospital & LUMC)
• Referral Rewards Perks Program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees