UM Intake Specialist

Lucent Health Solutions LLC•Nashville, TN

About The Position

The UM Admin Support Specialist provides administrative and operational support to the Utilization Management team, ensuring timely and accurate intake, processing, and tracking of prior authorization, referral, and case review requests. The role coordinates among members, providers, and clinical reviewers by managing correspondence, scheduling, data entry, and reporting, helping maintain smooth operations and compliance with regulatory and accreditation standards. The ideal candidate has healthcare or health plan administration experience and can manage multiple queues, deadlines, and stakeholders in a fast-paced environment.

Requirements

High school diploma or equivalent.
At least 2 years of experience in a healthcare administrative role, preferably in utilization management, case management, or a health plan/payer setting.
Working knowledge of prior authorization and referral processes, medical terminology, and basic ICD-10/CPT coding concepts.
Proficiency with UM or case management software platforms and Microsoft Office, including Outlook, Excel, and Word.
Strong organizational skills and ability to manage multiple queues and deadlines simultaneously.
Excellent written and verbal communication skills and a professional, service-oriented approach to providers and members.
Understanding of HIPAA privacy requirements and commitment to protecting confidential protected health information (PHI).

Nice To Haves

Associate's degree in healthcare administration or a related field.
Experience supporting URAC- or NCQA-accredited UM programs.
Familiarity with stop-loss, self-funded, or TPA administrative environments.
Experience generating and interpreting operational reports and dashboards.

Responsibilities

Receive, log, and triage incoming prior authorization, referral, and concurrent review requests from providers, members, and internal systems, including fax, portal, and EDI.
Enter data and set up cases in the UM platform, verifying member eligibility, provider information, and requested services before clinical review.
Route cases to the appropriate nurse reviewer, medical director, or delegate based on urgency, service type, and established workflows; monitor turnaround-time clocks to meet regulatory deadlines.
Prepare, send, and track correspondence to members and providers, including approval letters, denial notifications, and requests for additional clinical information.
Assist with scheduling peer-to-peer reviews, appeals, and internal case conferences, coordinating calendars across nurses, medical directors, and external providers.
Handle outgoing auto-authorization faxes and ensure timely processing and accurate routing to external providers.
Manage escalations and case query emails, responding promptly and routing them to clinical or leadership staff as needed.
Respond to provider and member inquiries about case status, required documentation, and next steps; escalate clinical questions to licensed staff as appropriate.
Identify and flag process bottlenecks or recurring errors and support continuous improvement of UM administrative workflows.
Assist with special projects, audits, and accreditation preparation as assigned.
Perform other duties consistent with the scope, level, and general responsibilities of the position.