The role of the Utilization Management Coordinator is to promptly, efficiently and accurately execute all aspects of the referral process. Promote the quality of medical care through strict adherence to all UM policy and procedure.
Essential Functions
· Data entry via EZ CAP software
· Communicate effectively and interact with the utilization review nurse and health plans daily or as indicated regarding UM and referral authorization issues
· Process request that are approved, denied or deferred and in accordance with utilization management policy and procedure
· Responsible for deferred authorization maintenance, tracking and follow up
· Responsible for log maintenance and member notifications
· Maintain regulatory Turn Around Time (TAT) Standards per CMS (Seniors)
· Returns phone calls to members, physicians and health plans and follow up with requests
· Maintain turnaround time compliance in all aspects of the UM process
· Maintain all reference material that is provided by the supervisor, manager or director
· Maintain patient confidentiality so that HIPAA compliance is observed at all times
· Know and follow the Employee Handbook policies and procedures
· Maintains quality monitors as assigned by Manager
· Assists other staff and supports the team approach
· Communicates appropriately and clearly to management, co-workers, and physicians
· Other Duties as assigned
Qualifications/Requirements
· Knowledge of Healthcare and Managed Care preferred
· Ability to multi-task and meet deadlines
· Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
· Typing 40 words per minutes with accuracy
· Knowledge of healthcare protocols/procedures, including healthcare coding
· Knowledge of coordination of benefits
· Knowledge of Medicare processing guidelines
· Knowledge of the EZ-Cap and Crystal operating system
· Ability to project a pleasant and professional image
· Ability to plan, prioritize and complete delegated tasks
· Ability to demonstrate compassion and caring in dealing with others
Job Type: Full Time
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
401K
Paid Time Off
Job Type: Full-time
Pay: $22.00 - $24.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Ability to commute/relocate:
- Bakersfield, CA 93309: Reliably commute or planning to relocate before starting work (Required)
Experience:
- Utilization review: 2 years (Preferred)
License/Certification:
Work Location: In person