UM Intake Specialist

Lucent Health Solutions LLC•Nashville, TN

About The Position

The UM Admin Support Specialist provides essential 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. This role serves as a key point of coordination between members, providers, and clinical reviewers — managing correspondence, scheduling, data entry, and reporting to keep UM operations running smoothly and in compliance with regulatory and accreditation standards. The ideal candidate brings prior experience in healthcare or health plan administration and is comfortable juggling multiple queues, deadlines, and stakeholders in a fast-paced environment.

Requirements

High school diploma or equivalent required; Associate's degree in healthcare administration or related field preferred.
2+ years of experience in a healthcare administrative role, preferably within 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/case management software platforms and Microsoft Office (Outlook, Excel, Word).
Strong organizational skills with the ability to manage multiple queues and deadlines simultaneously.
Excellent written and verbal communication skills, with a professional and service-oriented approach to providers and members.
Understanding of HIPAA privacy requirements and commitment to maintaining confidentiality of protected health information (PHI).

Nice To Haves

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 (fax, portal, EDI).
Perform accurate data entry and case setup in the UM platform, verifying member eligibility, provider information, and requested services prior to clinical review.
Route cases to the appropriate nurse reviewer, medical director, or delegate based on urgency, service type, and established workflows; monitor turnaround-time (TAT) clocks to ensure regulatory deadlines are met.
Prepare, send, and track written correspondence to members and providers, including approval letters, denial notifications, and requests for additional clinical information.
May assist with scheduling peer-to-peer reviews, appeals, and internal case conferences; coordinate calendars across nurses, medical directors, and external providers.
Handle outgoing auto-authorization faxes, ensuring timely processing and accurate routing to external providers.
Manage escalations and case query emails, ensuring timely response and appropriate routing to clinical or leadership staff as needed.
Respond to provider and member inquiries regarding case status, required documentation, and next steps, escalating 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.
Other duties as assigned consistent with the scope, level and general responsibilities of this position.